MO718ROLE OF CT-PERITONEOGRAPHY IN THE PATIENT WITH GENITAL EDEMA AND PERITONEAL DIALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Francisco Javier Centellas Pérez ◽  
Agustin Ortega Cerrato ◽  
Juan Pérez Martínez ◽  
Francisco Llamas Fuentes
Keyword(s):  
Peritoneal Dialysis ◽  
Diagnostic Technique ◽  
Abdominal Pressure ◽  
Inguinal Hernioplasty ◽  
Peritoneal Catheter ◽  
Iodinated Contrast ◽  
Dialysis Solution ◽  
Subcutaneous Edema ◽  
Scrotal Edema

Abstract Background and Aims Genital edema is a frequent complication in those patients who are on peritoneal dialysis, generally secondary to the increase in intra-abdominal pressure that it entails. It occurs late after the implantation of the peritoneal catheter (after 30 days of implantation). The typical clinical manifestation of this condition is basically subcutaneous edema in the genital area, accompanied by pain and UF failure. The diagnosis must be made by using an imaging test, mainly CT-peritoneography. Method A series of clinical cases of PD patients who consulted for genital edema is reviewed, analyzing the role of peritoneography Results CASE 1 A 76-year-old male, 15 days after the start of the technique, consulted for right scrotal edema. It was decided to suspend CAPD and start hospital intermittent IPD with low volumes. A CT-peritoneography was requested, which revealed a right peritoneal-vaginal duct and a left inguino-scrotal leak. Surgical correction of the anatomical defect was performed without incident, with subsequent return of the patient to CAPD. CASE 2 A 78-year-old man, 15 days after the start of the technique, consulted for bilateral scrotal edema. A CT-peritoneography was performed, which showed that the leak of peritoneal fluid to the scrotum was due to bilateral inguinal hernia. Subsequently, inguinal hernioplasty of the surgical defect was performed without complications. Conclusion Genital edema, as a complication of patients with CAPD, appears in approximately 4-10% of them. CT-peritoneography is the diagnostic technique of choice. To do this, 150 ml of nonionic iodinated contrast, with a concentration of 300 mg/ml, are diluted in approximately 2 liters of dialysis solution, which are introduced into the peritoneal cavity of the patient 2 h before performing the CT. Subsequently, a CT scan of the abdomen and pelvis including the perineum is performed, in the supine position and craniocaudal direction.

scholarly journals Gastrointestinal Non-Infectious Complications in Patients on Peritoneal Dialysis

2016 ◽  
Vol 17 (2) ◽  
pp. 153-160
Author(s):  
Milica Kostović ◽  
Milica Cvetkovic ◽  
Dejan Petrovic
Keyword(s):  
Risk Factors ◽  
Acute Pancreatitis ◽  
Peritoneal Dialysis ◽  
Secondary Hyperparathyroidism ◽  
Patient Population ◽  
Abdominal Pressure ◽  
Gastrointestinal Complications ◽  
Dialysis Solution ◽  
Abdominal Hypertension ◽  
Peritoneal Dialysis Solution

Abstract Gastrointestinal complications are common among patients on peritoneal dialysis. Risk factors for the development of gastrointestinal complications in this patient population include: toxic effects of uremic toxins, frequent use of nonsteroidal anti-inflammatory drugs, Helicobacter pylori infection, angiodysplasia, increased intra-abdominal pressure, use of bioincompatible solution for peritoneal dialysis, increased glucose in solutions for peritoneal dialysis, secondary hyperparathyroidism (hypercalcemia), a disorder of lipid metabolism (hypertriglyceridemia), and the duration of peritoneal dialysis treatment. The most important non-infectious gastrointestinal complications in patients on peritoneal dialysis are: gastrointestinal bleeding, herniation and leaking of the dialysate from the abdomen (increased intra-abdominal pressure), impaired lung function (intra-abdominal hypertension), acute pancreatitis, and encapsulating sclerosis of the peritoneum. Intra-abdominal hypertension is defined as IAP ≥ 12 mmHg. Pouring the peritoneal dialysis solution leads to increased intra-abdominal pressure, which results in the development of hernias, pleuro-peritoneal dialysate leakage (hydrothorax), and restrictive pulmonary dysfunction. Risk factors for the development of acute pancreatitis in this patient population include: uraemia, secondary hyperparathyroidism with hypercalcemia, hypertriglyceridemia, features of the peritoneal dialysis solution (osmolarity, acidity, glucose, chemical irritation, and calcium in the solution for peritoneal dialysis lead to “local hypercalcemia”), toxic substances from the dialysate, the bags and tubing, and peritonitis and treatment of peritonitis with antibiotics and anticoagulants. Encapsulating sclerosis of the peritoneum is rare and is the most serious complication of long-term peritoneal dialysis. It is characterized by thickening of the peritoneum, including cancer, and signs and symptoms of obstructive ileus. Diagnosis is based on clinical, laboratory and radiological parameters. Encapsulating sclerosis of the peritoneum can be indicated by an AR-CA-125 concentration of less than 33 U/min and a concentration of AR-IL-6 greater than 350 pg/min in the effluent of patients with ultrafiltration weakness. Treatment consists of stopping peritoneal dialysis, using anti-inflammatory (corticosteroids) and anticicatricial drugs (tamoxifen), while surgical treatment includes enterolysis and adhesiolysis.

scholarly journals Peritoneal Dialysis Catheter Increases Leukocyte Recruitment in the Mouse Parietal Peritoneum Microcirculation and Causes Fibrosis

2016 ◽  
Vol 36 (1) ◽  
pp. 7-15 ◽  
Author(s):  
Paulina M. Kowalewska ◽  
Peter J. Margetts ◽  
Alison E. Fox-Robichaud
Keyword(s):  
Peritoneal Dialysis ◽  
Endothelial Cell ◽  
Solution Treatment ◽  
Cell Interactions ◽  
Parietal Peritoneum ◽  
Peritoneal Dialysis Catheter ◽  
Peritoneal Fibrosis ◽  
Peritoneal Catheter ◽  
Dialysis Treatment ◽  
Dialysis Solution

♦BackgroundThe objective of this study was to examine the effects of a conventional dialysis solution and peritoneal catheter on leukocyte- endothelial cell interactions in the microcirculation of the parietal peritoneum in a subacute peritoneal dialysis (PD) mouse model.♦MethodsAn intraperitoneal (IP) catheter with a subcutaneous injection port was implanted into mice and, after a 2-week healing period, the animals were injected daily for 6 weeks with a 2.5% dextrose solution. Intravital microscopy (IVM) of the parietal peritoneum microcirculation was performed 4 hours after the last injection of the dialysis solution. Leukocyte-endothelial cell interactions were quantified and compared with catheterized controls without dialysis treatment and naïve mice.♦ ResultsThe number of rolling and extravascular leukocytes along with peritoneal fibrosis and neovascularization were significantly increased in the catheterized animals compared with naïve mice but did not significantly differ between the 2 groups of catheterized animals with sham injections or dialysis solution treatment.♦ConclusionThe peritoneal catheter implant increased leukocyte rolling and extravasation, peritoneal fibrosis and vascularization in the parietal peritoneum independently from the dialysis solution treatment.

scholarly journals Chronic peritoneal dialysis in children: the role of ultrasound in the diagnosis of peritoneal catheter obstruction

2016 ◽  
Vol 19 (3) ◽  
pp. 191-196 ◽  
Author(s):  
Francesco Esposito ◽  
Marco Di Serafino ◽  
Concetta Ambrosio ◽  
Maria Rita Panico ◽  
Francesca Malacario ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Chronic Peritoneal Dialysis ◽  
Peritoneal Catheter ◽  
Catheter Obstruction

scholarly journals The importance of the peritoneal dialysis catheter material in orderto perform optimum dialysis in veterinary medicine

2020 ◽  
Vol 71 (06) ◽  
pp. 596-599
Author(s):  
BOGDAN ALEXANDRU VIŢĂLARU ◽  
RAZVAN SCARLAT
Keyword(s):  
Veterinary Medicine ◽  
Peritoneal Dialysis ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Peritoneal Catheter ◽  
The Third ◽  
Dialysis Solution ◽  
Peritoneal Dialysis Solution

This study was conducted on 44 dogs, aged between 10 months and 15 years, weighing between 0.9 and 8.5 kilograms,during 72 months. We created four batches of 11 dogs each. First batch received silicone peritoneal catheters with twoDacron cuffs, second batch received silicone peritoneal catheters without Dacron cuffs, third batch receivedpolypropylene peritoneal catheters with two Dacron cuffs and fourth batch received polypropylene peritoneal catheterswithout Dacron cuffs. All the dogs were treated with the same peritoneal dialysis solution, at the same interval, in thesame doses and at the same temperature and all the peritoneal catheters were straight Blake. In dogs from the firstbatch, we experienced minimum subcutaneous leaks of peritoneal dialysis solution and the catheters were permeablefor at least 90 days. In the second batch, we experienced constant and reduced subcutaneous leaks of peritonealdialysis solution and the catheters were permeable for at least 90 days. In the third batch, we experienced mediumsubcutaneous leaks of peritoneal dialysis solution and the catheters were permeable for at least 45 days. In the fourthbatch, we experienced important subcutaneous leaks of peritoneal dialysis solution and the catheters were permeablefor at most 15 days. The study conclusion is that the best peritoneal catheter it is represented by the silicone peritonealcatheters with two Dacron cuffs.

scholarly journals The importance of the peritoneal dialysis catheter material in orderto perform optimum dialysis in veterinary medicine

2020 ◽  
Vol 71 (06) ◽  
pp. 596-599
Author(s):  
BOGDAN ALEXANDRU VIŢĂLARU ◽  
RAZVAN SCARLAT
Keyword(s):  
Veterinary Medicine ◽  
Peritoneal Dialysis ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Peritoneal Catheter ◽  
The Third ◽  
Dialysis Solution ◽  
Peritoneal Dialysis Solution

This study was conducted on 44 dogs, aged between 10 months and 15 years, weighing between 0.9 and 8.5 kilograms,during 72 months. We created four batches of 11 dogs each. First batch received silicone peritoneal catheters with twoDacron cuffs, second batch received silicone peritoneal catheters without Dacron cuffs, third batch receivedpolypropylene peritoneal catheters with two Dacron cuffs and fourth batch received polypropylene peritoneal catheterswithout Dacron cuffs. All the dogs were treated with the same peritoneal dialysis solution, at the same interval, in thesame doses and at the same temperature and all the peritoneal catheters were straight Blake. In dogs from the firstbatch, we experienced minimum subcutaneous leaks of peritoneal dialysis solution and the catheters were permeablefor at least 90 days. In the second batch, we experienced constant and reduced subcutaneous leaks of peritonealdialysis solution and the catheters were permeable for at least 90 days. In the third batch, we experienced mediumsubcutaneous leaks of peritoneal dialysis solution and the catheters were permeable for at least 45 days. In the fourthbatch, we experienced important subcutaneous leaks of peritoneal dialysis solution and the catheters were permeablefor at most 15 days. The study conclusion is that the best peritoneal catheter it is represented by the silicone peritonealcatheters with two Dacron cuffs.

New Animal Models for Encapsulating Peritoneal Sclerosis—Role of Acidic Solution

2001 ◽  
Vol 21 (3_suppl) ◽  
pp. 349-353 ◽  
Author(s):  
Hidetomo Nakamoto ◽  
Hiroe Imai ◽  
Yuji Ishida ◽  
Yasuhiro Yamanouchi ◽  
Tsutomu Inoue ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Fibrosis ◽  
Solution Ph ◽  
Group Iii ◽  
Group I ◽  
Dialysis Solution ◽  
Wistar Kyoto ◽  
Dialysis Solutions

Objective Encapsulating peritoneal sclerosis (EPS), in which all or part of the intestine is enveloped in a fibrous ball resembling a cocoon, is a serious complication of peritoneal dialysis (PD). The aim of the present study was to investigate whether pH-neutral or acidic dialysis solutions induce peritoneal fibrosis. Design We divided 18 male Wistar–Kyoto (WKY) rats into three groups and dialyzed them with various solutions as follows: group I, 10 mL acidic dialysis solution (pH 3.8, containing 1.35% glucose), n = 6; group II, 10 mL pH 5.0 dialysis solution, n = 6; and group III, 10 mL neutral dialysis solution (pH 7.0), n = 6. Peritoneal catheters were inserted, and dialysis solution was injected every day for 40 days. At the end of the experiment, a peritoneal equilibration test (PET) was performed. Expression of mRNA of aquaporins 1 and 4 (AQP-1 and AQP-4) in the peritoneum were studied by semiquantitative reverse-transcriptase polymerase chain reaction (RT-PCR). Results In rats treated with pH 3.8 dialysis solution, necropsy findings revealed features identical to those of EPS. The typical appearance was of granulation tissue or fibrotic tissue (or both) covering multiple surfaces. Multiple adhesions were present. In microscopic examinations, peritoneal fibrosis and loss of mesothelium were found. In rats treated with pH 7.0 dialysis solution, no signs of EPS were seen. In rats treated with pH 5.0 dialysis solution, milder changes (subserosal thickening and partial adhesion of the peritonea) were observed. The mRNA of AQP-1 and AQP-4 were expressed in the peritonea of the rats. The expression of the AQPs was significantly suppressed in rats treated with pH 3.8 dialysis solution. Conclusions In rats, long-term intraperitoneal injection of acidic dialysis solution produced features typical of EPS in humans. Newly developed neutral dialysis solutions protected the against the development of EPS during peritoneal dialysis in rats.

The Role of Omentectomy in Continuous Ambulatory Peritoneal Dialysis

1991 ◽  
Vol 11 (4) ◽  
pp. 330-332 ◽  
Author(s):  
Michael L. Nicholson ◽  
Paul R. Burton ◽  
Peter K. Donnelly ◽  
Peter S. Veitch ◽  
John Walls
Keyword(s):  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Surgical Technique ◽  
Proportional Hazards ◽  
Significant Risk ◽  
Peritoneal Catheter ◽  
Term Survival ◽  
Catheter Survival

Long-term survival of the peritoneal catheter is essential for successful CAPD. In our unit, all CAPD catheters are now placed by an open surgical technique, which in some cases has included performing a partial omentectomy. The aim of this study was to assess the influence of omentectomy on CAPD catheter survival. Three hundred consecutive CAPD catheters inserted over a 5-year period were analyzed. Omentectomy was performed in 113 cases (38%). Data relating to a number of potentially significant risk/benefit factors were analyzed using multiple regression analysis (proportional hazards method of Cox). Performing a partial omentectomy at the time of catheter insertion was found to significantly improve CAPD catheter survival (p=0.0002).

Continuous Ambulatory Peritoneal Dialysis Complicated by Fournier's Syndrome

1987 ◽  
Vol 7 (3) ◽  
pp. 193-194 ◽  
Author(s):  
J. Joseph Walshe ◽  
Padma V. Reddy
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Early Recognition ◽  
External Genitalia ◽  
High Morbidity ◽  
Prompt Treatment ◽  
Serious Infection ◽  
Scrotal Edema ◽  
Male External Genitalia

Two patients developed Fournier's syndrome while on continuous ambulatory peritoneal dialysis. In both cases, massive scrotal edema appears to have been the precipitating cause of the polymicrobial genital infection. Early recognition and prompt treatment of this syndrome is essential if one is to avoid the high morbidity and mortality associated with this disease. Fournier's syndrome, first described in 1883, is a fulminant necrotising subcutaneous infection of the male external genitalia (I). Although initially thought to be idiopathic, recent evidence suggests that an underlying condition can usually be identified as the precipitating cause of this rare but serious infection (2, 3). Herein, we describe two patients who developed massive scrotal edema while on continuous ambulatory peritoneal dialysis (CAPO). Subsequently, both patients suffered polymicrobial infections of the scrotum with necrosis. We discuss the possible role of CAPO and scrotal edema in leading to the development of Fournier's syndrome.

scholarly journals Reducing Cardiometabolic Risk in Peritoneal Dialysis Patients: Role of the Dialysis Solution

2009 ◽  
Vol 3 (6) ◽  
pp. 1472-1480 ◽  
Author(s):  
Clifford J. Holmes
Keyword(s):  
Peritoneal Dialysis ◽  
Cardiometabolic Risk ◽  
Glucose Absorption ◽  
Fluid Removal ◽  
Dialysis Solution ◽  
Clinical Strategies ◽  
Patients With Diabetes ◽  
Osmotic Agent ◽  
Dialysis Solutions

Peritoneal dialysis (PD) is a well-established form of therapy for stage 5 chronic kidney disease requiring renal replacement therapy. D-Glucose has been used successfully for several decades as the osmotic agent employed in dialysis solutions to achieve adequate fluid removal. The absorption of 100–200 grams of glucose per day has been suggested as potentially increasing cardiometabolic risk, particularly in patients with diabetes. Supporting and undermining evidence for this hypothesis is reviewed, with a focus on the role of glucose absorption in changes in body composition, dyslipidemia, and glycemic control in diabetic PD patients. Clinical strategies to optimize fluid removal while minimizing the metabolic impact of glucose absorption are also discussed.

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