Encysted Fluid Collections after Catheter Removal for Peritonitis in Peritoneal Dialysis Patients

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Hasan Abu-Aisha
Elwaleed A M Elhassan
Maha A Hummeida
Osman-mahir M A Mahir
Hisham M Ali
Aymun I Mobarak
Jamal Abdel-Raheem
Um-Alhasan Mohamed
Hassan A Musa
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Introduction: Peritonitis is a frequent complication of continuous ambulatory peritoneal dialysis (CAPD). This case series describes episodes of peritoneal dialysis (PD) related fungal or Pseudomonas peritonitis that were complicated by the formation of encysted intra abdominal fluid collections despite prompt catheter removal and appropriate therapy. Case series: The first patient presented with fever and abdominal pain two weeks after removing his PD catheter because of fungal peritonitis. Examination revealed fluid collection in the former catheter tunnel. This turned out to be pus on surgical drainage. Abdominal computed tomography (CT) scan revealed another extensive encysted extra-peritoneal fluid collection that was aspirated and found to be clear transudate fluid. The second patient presented with abdominal pain and distention seven weeks after removing her PD catheter because of fungal peritonitis. She had a large intra abdominal encysted fluid collection that was drained under ultra sound guidance. The third patient presented with painless abdominal distention one month after removing the PD catheter because of Pseudomonas peritonitis. He had two encysted extra peritoneal fluid collections that were aspirated under ultra sound guidance. This occurred despite three weeks of treatment with oral fluconazole in the case of the first two patients and appropriate antibiotic therapy in the case of the third patient. Conclusion: In fungal and Pseudomonas peritonitis, other measures besides immediate initiation of appropriate therapy and prompt removal of the catheter may be necessary to prevent such late complications. Suggested measures include continued intraperitoneal antibiotics by a fresh PD catheter, in addition to systemic antifungal treatment
Elhassan, E., Hummeida, H., Mahir, O.M., Ali, H., Mobaraka, A., Raheem, J., Mohamed, U., Musa, H. and Abu-Aisha, H., 2008. Encysted fluid collections after catheter removal for peritonitis in peritoneal dialysis patients. Arab Journal of Nephrology and Transplantation, 1(1), pp.25-28.