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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
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Table of Contents   
LETTERS TO THE EDITOR
Year : 2021  |  Volume : 26  |  Issue : 5  |  Page : 364-365
 

Delayed rectal perforation: A rare complication of chronic peritoneal dialysis catheter in pediatrics and its treatment without exploration


Department of Pediatric Surgery, Maternity and Children's Hospital, Al Muraikabat, Dammam 32253, Eastern Province, Saudi Arabia

Date of Submission14-Mar-2021
Date of Decision21-Apr-2021
Date of Acceptance04-Jun-2021
Date of Web Publication16-Sep-2021

Correspondence Address:
Dr. Mukul R Kothari
Department of Pediatric Surgery, Maternity and Children's Hospital, Al Muraikabat, Dammam 32253, Eastern Province
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.JIAPS_41_21

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How to cite this article:
Kothari MR, AlMoaily MS. Delayed rectal perforation: A rare complication of chronic peritoneal dialysis catheter in pediatrics and its treatment without exploration. J Indian Assoc Pediatr Surg 2021;26:364-5

How to cite this URL:
Kothari MR, AlMoaily MS. Delayed rectal perforation: A rare complication of chronic peritoneal dialysis catheter in pediatrics and its treatment without exploration. J Indian Assoc Pediatr Surg [serial online] 2021 [cited 2022 Jul 6];26:364-5. Available from: https://www.jiaps.com/text.asp?2021/26/5/364/326071




Sir,

A 22-month-old male child was brought to the emergency department by the parents due to protrusion of peritoneal dialysis (PD) catheter from anus for last 3 days. The PD catheter was inserted in another center soon after birth for congenital hypolpastic kidneys, first on the left side and later revised and reinserted on the right due to blockage. The catheter was in continuous use until about 3 months back when PD was discontinued as his renal functions normalized. He was planned for catheter removal but could not go due to COVID-19 lockdown.

He was feeding well, passing stool normally, had no history of fever or vomiting. His abdomen was soft and nontender with the PD catheter in place. Curled end of the catheter was seen protruding from the anus [Figure 1]a and [Figure 1]b. His blood investigations including renal functions were within normal limits. He was started on intravenous antibiotics. X-ray abdomen showed the catheter in place without dilated bowel loops and no free air. Ultrasound showed bilateral echogenic kidneys with poor corticomedullary differentiation and catheter within rectal lumen without any pelvic collection.
Figure 1: (a) Peritoneal dialysis catheter in place. (b) Curved end of the catheter protruding through rectum.

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Next day under general anesthesia the catheter was flushed with iodine-saline solution. Catheter entry site into the peritoneum was opened. The preperitoneal cuff was dissected, and the catheter was transected below the cuff. The lower segment was pulled out from the rectum to avoid contaminating the tunnel with fecal matter. Abdomen was not explored. Upper end was removed, and main wound was cleaned and closed. Exit site wound was left open. The patient remained well and started feeding next day. He passed normal stools and his abdomen remained soft and nontender. He was discharged 72 h after the procedure with oral antibiotics.

In the pediatric age group, delayed perforation of bowel is not seen even in some of the large series reporting on PD catheter-related complication in children. During the search of English language literature, we came across only 4 previously reported cases of delayed bowel erosion by PD.[1],[2],[3],[4] Exact mechanism of PD catheters eroding the bowel is unknown. Lack of fluid around the catheter leading to dry rubbing of the catheter against bowel[4] has been suggested mechanism of delayed erosion of bowel. This usually occurs when a PD catheter is left unused for a prolonged period following recovery of renal function or post-transplant. Catheter removal only without exploration has been reported in only 5 patients in adult series.[5] Among the reported pediatric cases, only one case with delayed perforation of small bowel underwent removal of catheter only.[3] Ours is the second pediatric case with delayed perforation who was treated with simple removal of catheter and first one with rectal perforation and anal protrusion of catheter treated in such manner.

Following the diagnosis of bowel perforation if the patient is asymptomatic and radiological studies do not show any evidence of leak or collection inside the peritoneal cavity it is recommended that the catheter can be simply removed without exploration or attempt to close the perforation.[3] The patient should be observed closely for any post removal leak especially if the patient is on immunosuppression. Removal of catheter without exploration is contraindicated in a patient showing any signs of peritonitis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.



 
   References Top

1.
Saweirs WW, Casey J. Asymptomatic bowel perforation by a Tenckhoff catheter. Perit Dial Int 2005;25):195-6.  Back to cited text no. 1
    
2.
Askenazi D, Katz A, Tenney F, Benfield M, Barnhart D. An unusual case of peritoneal dialysis malfunction. Kidney Int 2007;72:524.  Back to cited text no. 2
    
3.
Markel TA, West KW. Management of peritoneal dialysis catheters that erode into bowel: Two pediatric case reports and a review of the literature. Perit Dial Int 2016;36:680-4.  Back to cited text no. 3
    
4.
Maxted AP, Davies B, Colliver D, Williams A, Lunn A. Peritoneal dialysis catheter removal post-transplant - a rare case of delayed bowel perforation. Perit Dial Int 2017;37:650-1.  Back to cited text no. 4
    
5.
Handa T, Suzuki H, Matsubara H, Terajima H, Tsukamoto T. Unusual communication of an embedded peritoneal dialysis catheter with the colon before use: a case report with literature review. Ren Replace Ther 2019; 5: 24.  Back to cited text no. 5
    


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