Journal of Yeungnam Medical Science

Case Reports

Severe ileus after colonoscopy in a patient on peritoneal dialysis: Sang Un Kim, Su Hee Kim, So Yoon Hwang, Ryang Hi Kim, Ji Young Choi, Jang Hee Cho, Chan Duck Kim, Yong Lim Kim, Sun Hee Park; Yeungnam Univ J Med. 2017;34(1):119-122. Published online June 30, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.1.119

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Abstract PDF: Peritoneal dialysis (PD) is associated with the development of various complications, such as exit site infection or peritonitis, and rarely, intestinal obstruction in prolonged PD patients with recurrent peritonitis. However, post-colonoscopy acute intestinal obstruction has not been reported in PD patients to date. Herein, we report a case of severe ileus after a colonoscopy without previous episodes of peritonitis in a PD patient. A 51-year-old man undergoing PD for 7 years visited our emergency department due to severe abdominal pain and vomiting after colonoscopic polypectomy. A simple abdominal radiography and abdominal computed tomography showed ileus with collapsed distal ileal loop. A peritoneal dialysate study revealed no evidence of peritonitis. The patient was treated with decompression therapy, and ileus was successfully treated without complications. This case suggests that it is not only necessary to prevent peritonitis, but also important to monitor the development of ileus after colonoscopy in PD patients.

Incarcerated umbilical hernia with small bowel obstruction in a continuous ambulatory peritoneal dialysis patient.: Yo Han Jeong, Jun Young Do, Mun Ju Hwang, Min Jung Kim, Min Geun Gu, Byung Sam Park, Jung Eun Choi, Tae Woo Kim; Yeungnam Univ J Med. 2014;31(1):25-27. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.25

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Patients treated with peritoneal dialysis have increased intra-abdominal pressure and a high prevalence of abdominal wall complications. Hernias can lead to significant morbidity in patients on peritoneal dialysis. Hernias are clinically important because of the risk of incarceration, strangulation and subsequent bowel obstruction, rupture, and peritonitis. In this paper, a case of incarcerated umbilical hernia with small bowel obstruction in a continuous ambulatory peritoneal dialysis (CAPD) patient is reported. The small bowel obstruction improved after herniorrhaphy, and the peritoneal dialysis was resumed 2 weeks after the herniorrhaphy. The patient had been undergoing CAPD without technical failure until the 2 months follow-up after the herniorrhaphy. This case shows that early detection of incarcerated umbilical hernia and herniorrhaphy can prevent resection of a strangulated small bowel so that it can remain on CAPD without post-operative technical failure. Umbilical hernias should be carefully observed and intestinal obstruction should be considered when a CAPD patient with an umbilical hernia has abdominal pain.

Citations

Citations to this article as recorded by

Clinical benefits of routine examination and synchronous repair of occult inguinal hernia during laparoscopic peritoneal dialysis catheter insertion: a single-center experience
H.-W. Kou, C.-N. Yeh, C.-Y. Tsai, J.-T. Hsu, S.-Y. Wang, C.-W. Lee, M.-C. Yu, T.-L. Hwang
Hernia.2021; 25(5): 1317. CrossRef

A Case of Continuous Ambulatory Peritonitis Dialysis Peritonitis Due to Stenotrophomonas maltophilia Using Antibiotic Combination.: Hee Sung Ko, Ah Ran Choi, Tae Hoon Kim, Chan Hee Kyung, Jang Ho Cho, Yong Hoon Kim, Jung Eun Lee; Yeungnam Univ J Med. 2013;30(2):109-111. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.109

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Abstract PDF: Continuous ambulatory peritoneal dialysis (CAPD) peritonitis is a major complication of peritoneal dialysis (PD) and leads to the discontinuation of PD. Despite its limited pathogenicity, CAPD peritonitis caused by Stenotrophomonas maltophilia (S. maltophilia), an important nosocomial pathogen that is present in nature and is usually associated with plastic indwelling devices. Infection of S. maltophilia is associated with a poor prognosis, including inability to maintain the CAPD catheter, because of its resistance to multiple antibiotics. We report a case of CAPD peritonitis due to S. maltophilia that was treated successfully using oral Trimethoprim-sulfame-thoxazole and intraperitoneal Ticarcillin/clavulanate without removing the dialysis catheter.

A Case of Neurotoxicity Induced by Valaciclovir in a Continuous Ambulatory Peritoneal Dialysis Patient.: Joon Seok Kim, Jee Eun Yang, Bo Young Lee, Seohyun Lee, Hee Jung Park, Sunpyo Lee, Sang Koo Lee; Yeungnam Univ J Med. 2012;29(2):121-124. Published online December 31, 2012; DOI: https://doi.org/10.12701/yujm.2012.29.2.121

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Abstract PDF

Valaciclovir is metabolized to acyclovir after ingestion and thereafter exerts its antiviral activity. Because of its superior pharmacokinetic profile, it has quickly replaced acyclovir in the treatment of herpesvirus infection. Neurotoxicity caused by valaciclovir has been reported, however, among patients with pre-existing impaired renal function. This paper reports a case of neurotoxicity of valaciclovir in a patient with end-stage renal disease who was undergoing continuous ambulatory peritoneal dialysis (CAPD). A 67-year-old female on CAPD took 500 mg of valaciclovir twice for herpes zoster. After she took her second dose orally, she developed confusion and disorientation, along with involuntary movements. Her mental confusion progressed to a coma. Discontinuation of valaciclovir showed no rapid improvement. There- fore, hemodialysis was started. After two sessions of hemodialysis, the patient became alert; and after four sessions of hemodialysis, her neurological abnormalities were completely reversed. In conclusion, valaciclovir can induce life-threatening neurotoxicity, especially in CAPD patients, even with appropriate dose reduction, which can be effectively managed by hemodialysis.

Citations

Citations to this article as recorded by

Comparison of Renal Function Indicators According to Hydration Volume in Patients Receiving Intravenous Acyclovir With CNS Infection
Sanghee Kim, Youngsoon Byun
Biological Research For Nursing.2015; 17(1): 55. CrossRef
Valacyclovir-Induced Neurotoxicity in a Maintenance Hemodialysis Patient
June Seong Hwang, Hyo Yoep Song, Hoon Gil Jo, Song I Lee, Byung Hun Lim, Jung Sub Song, Seon Ho Ahn
Journal of the Korean Geriatrics Society.2014; 18(2): 85. CrossRef

A Case of Exit-Site Infection and Abscess by Mycobacterium Abscessus in a CAPD Patient.: Sun Young Jung, Ji Hoon Na, Kyu Hyang Cho, Jong Won Park, Jun Young Do, Kyeung Woo Yun, In Wook Song, Jeong Hwan Cho, Chang Woo Son; Yeungnam Univ J Med. 2009;26(2):137-143. Published online December 31, 2009; DOI: https://doi.org/10.12701/yujm.2009.26.2.137

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Abstract PDF

Nontuberculous mycobacterial infections are a rare, but clinically important cause of infections in continuous ambulatory peritoneal dialysis (CAPD) patients. This is typically suspected when a patient does not respond to treatment with the usual antibiotics. We describe here a case of Mycobacterium abscessus exit site infection with abdominal wall abscess formation that was associated with CAPD, which required peritoneal catheter removal, surgical debridement of the abscess and long term antibiotic therapy.

Citations

Citations to this article as recorded by

A Case Report ofMycobacterium abscessusPeritonitis in a Patient on Continuous Ambulatory Peritoneal Dialysis
Seon Joo Kang, Heungsoo Kim, Kyoung Un Park, Young Ae Lim, Wee Gyo Lee
Annals of Clinical Microbiology.2013; 16(2): 101. CrossRef
A Case of Continuous Ambulatory Peritonitis Dialysis Peritonitis Due toStenotrophomonas maltophiliaUsing Antibiotic Combination
Hee Sung Ko, Ah Ran Choi, Tae Hoon Kim, Chan Hee Kyung, Jang Ho Cho, Yong Hoon Kim, Jung Eun Lee
Yeungnam University Journal of Medicine.2013; 30(2): 109. CrossRef

A Case of Pneumatosis Intestinalis in Peritoneal Dialysis Peritonitis.: Sun Young Jung, Ji Hun Na, Yun Jung Choi, Sung Ae Koh, Ku Hyang Choi, Jong Won Park, Jun Young Do, Kyeng Woo Yun; Yeungnam Univ J Med. 2009;26(1):49-55. Published online June 30, 2009; DOI: https://doi.org/10.12701/yujm.2009.26.1.49

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Abstract PDF: Peritonitis is a serious problem in patients undergoing peritoneal dialysis. Rarely pneumatosis intestinalis can occur as a complication of this infectious process. Pneumatosis intestinalis is a potential life threatening condition with a challenging management. The mortality of peritoneal dialysis patients with pneumatosis intestinalis secondary to mesenteric ischemia is almost 100%. We describe a rare case of pneumatosis intestinalis in a peritoneal dialysis patient who developed Staphylococcus aureus peritonitis which was initially treated with appropriate antibiotics. Since initial response to therapy was not achieved, an abdominal computerized tomography was done which revealed a pneumatosis intestinalis. A laparotomy was performed and small bowel necrosis was seen. A segmental resection with ileostomy, jejunostomy was done. Though surgical treatment was performed, the patient died in 2 weeks after admission. Pneumocystitis intestinalis in peritoneal dialysis peritonitis is a uncommon complication which requires prompt evaluation to rule out mesenteric ischemia as it carries a high mortality and its management will be surgical.

Original Articles

The Characteristics of Blood Pressure Control in Chronic Renal Failure Patients Treated with Peritoneal Dialysis.: Hang Jae Jung, Sung Hwa Bae, Jun Bum Park, Kyoo Hyang Jo, Young Jin Kim, Jun Young Do, Kyung Woo Yoon; Yeungnam Univ J Med. 1999;16(2):333-341. Published online December 31, 1999; DOI: https://doi.org/10.12701/yujm.1999.16.2.333

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Abstract PDF: BACKGROUND
AND METHODS: In order to evaluate characteristics and modulatory factors of blood pressure in peritoneal dialysis(PD), studies were conducted on the 69 patients who had underwent peritoneal equilibration test(PET). RESULTS: The results were as follows: 1) All patients received an antihypertensive drug before PD, but, 15 of 69 patients successfully quit taking the antihypertensive drug after peritoneal dialysis. 2) During peritoneal dialysis, mean arterial pressure(MAP) was significantlydecreased for the first 3 months, and this lasted for 1 year, and antihypertensive drug requirements were significantly decreased continuously up to 9 months(p<0.005). 3) After changing the modality from hemodialysis to peritoneal dialysis. MAP(mmHg, from 107.1+/-4.5 to 98.6+/-8.8, p<0.05), antihypertensive drug requirements(from 5.6+/-2.6, to 2.0+/-2.5, p<0.01) and erythropoietin dosages(Uint/week, from 4600+/-2660 to 2000+/-1630, p<0.05) were decreased. 4) Multiple logistic regression analysis showed that MAP(p<0.01) and daily ultrafiltration volume(p<0.05) can contribute to the determination of antihypertensive drug requirements. However the relationship between antihypertensive drug requirements and PET results or dialysis adequacy indices(weekly Kt/V. weekly creatinine clearance) was not revealed. CONCLUSION: In conclusion, the prescription of antihypertensive drugs should be considered according to daily ultrafiltration volume, especially during first year after initiating PD, and follow-ups for over a year may be needed.

Low volume peritoneal dialysis in newborns and infants.: Young Hoon Park, Soo Ho Ahn, Son Moon Shin, Jeong Ok Hah; Yeungnam Univ J Med. 1991;8(2):128-137. Published online December 31, 1991; DOI: https://doi.org/10.12701/yujm.1991.8.2.128

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Abstract PDF: Peritoneal dialysis has been widely considered to be the dialytic treatment of choice for acute renal failure in infants and young children, because the technique is simple, safe and easily adapted for these patients. Also peritoneal dialysis in infants might have more effective ultrafiltration and clearance than in adults. In certain circumstances associated with hemodynamic instability, ordinary volume peritoneal dialysis (30-50 ml/kg body weight per exchange) or hemodialysis may not be suitable unfortunately. But frequent cycled, low volume, high concentration peritoneal dialysis may be more available to manage the acute renal failure of newborns and infants. Seven infants underwent peritoneal dialysis for hemodynamically unstable acute renal failure with low exchange volume (14.2±4.2 ml/kg), short exchange time (30 to 45 minutes) and hypertonic glucose solution (4.25% dextrose). Age was 1.9±1.3 months and body weight was 4.6±1.6 kg. Etiology of acute renal failure was secondary to sepsis with or without shock (5 cases) and postcardiac operation (2 cases). Catheter was inserted percutaneously with pigtail catheter or Tenkhoff catheter by Seldinger method. Dialysate was commercially obtained Peritosol which contained sodium, chloride, potassium, magnesium, lactate and calcium. Net ultrafiltration (ml/min) showed no difference between low volume dialysis and control (0.27±0.09 versus 0.29±0.09). Blood BUN decreased from 95.7±37.5 to 75.7±25.9 mg/dl and blood pH increased from 7.122±0.048 to 7.326±0.063 after 24 hours of peritoneal dialysis. We experienced hyperglycemia which were controlled by insulin (2 episodes), leakage at the exit site (2), mild hyponatremia (1) and Escherichia coli peritonitis (1). Two children of low volume dialysis died despite the treatment. In our experience, low volume and high concentration peritoneal dialysis with frequent exchange may have sufficient ultrafiltration and clearance without significant complications in the certain risked acute renal failure of infants.

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