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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT Table of Contents   
Year : 2012  |  Volume : 23  |  Issue : 3  |  Page : 552-555
Bladder perforation in a peritoneal dialysis patient


1 Department of Internal Medicine A and Laboratory of Kidney Pathology LR 00 SP 01, Charles Nicolle's Hospital, Tunis, Tunisia
2 Department of Urology, Charles Nicolle's Hospital, Tunis, Tunisia

Correspondence Address:
M Ounissi
Department of Internal Medicine A, Charles Nicolle's Hospital, Boulevard du 9 Avril, 1006 BS-Tunis
Tunisia
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The dysfunction of the catheter in peritoneal dialysis (PD) is a frequent compli­cation. However, perforation of organs are rare, particularly that of the urinary bladder. This re­quires an early diagnosis and prompt treatment of patients. We report here the case of a 38-year-old woman having end-stage renal disease due to autosomal-dominant polycystic kidney disease treated by PD since November 2000. Three years later, she was treated for Staphylococcal peritonitis. Four months later, she presented with a severe urge to urinate at the time of the fluid exchanges. The biochemical analysis of the fluid from the bladder showed that it was dialysis fluid. Injection of contrast through the catheter demonstrated the presence of a fistula between the bladder and the peritoneal cavity. She underwent cystoscopic closure of the fistulous tract and the PD catheter was removed. Subsequently, the patient was treated by hemodialysis. One month later, a second catheter was implanted surgically after confirming the closure of the fistula. Ten days later, she presented with pain at the catheter site and along the tunnel, which was found to be swollen along its track. The injection of contrast produced swelling of the subcutaneous tunnel but without extravasation of the dye. PD was withdrawn and the patient was put back on hemodialysis. Bladder fistula is a rare complication in PD and diagnosis should be suspected when patient complains of an urge to pass urine during the exchanges, which can be confirmed by contrast study showing presence of dye in the bladder. PD may be possible after the closure of the fistula, but recurrence may occur.


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