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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2015  |  Volume : 26  |  Issue : 6  |  Page : 1305-1306
Dialysatoma - A complication of continuous ambulatory peritoneal dialysis


Department of Urology and Renal Transplant, Fortis Memorial Research Institute, Gurgaon, Haryana, India

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Date of Web Publication30-Oct-2015
 

How to cite this article:
Ahmed S, Sethia RK, Gogoi S. Dialysatoma - A complication of continuous ambulatory peritoneal dialysis. Saudi J Kidney Dis Transpl 2015;26:1305-6

How to cite this URL:
Ahmed S, Sethia RK, Gogoi S. Dialysatoma - A complication of continuous ambulatory peritoneal dialysis. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2021 Dec 3];26:1305-6. Available from: https://www.sjkdt.org/text.asp?2015/26/6/1305/168693
To the Editor,

Continuous ambulatory peritoneal dialysis (CAPD) is a well-established mode of dialysis for end-stage renal disease. Abdominal wall hernia is a common complication in patients on CAPD. [1],[2] We present a case of right lumbar swelling masquerading lumbar hernia and we coined the term "dialystoma" because it was a collection of dialysate in a closed interfacial cavity.

A six-year-old female child had been on CAPD daily for the past 5 years and presented with progressive swelling in the right lumbar region for the last three to four months. She had no history of pain from dialysis. Her parents denied any history of constipation or pain in the abdomen. On examination, there was a visible swelling of approximately 8 cm × 6 cm in the right lumbar region that was fluctuant and non-reducible with a positive cough impulse. She was advised for a contrastenhanced computed tomography of the abdomen with oral contrast [Figure 1], which showed a fluid density collection within the interfacial planes of approximately 10 cm × 5 cm in the abdominal wall with a small ostial communication with the peritoneal cavity; however, there were no intra-abdominal contents in the cavity. She was switched to hemodialysis before kidney transplant for three weeks and the swelling subsided during that period. She underwent renal transplant and, intraoperatively we found that there was a small rent in the peritoneum lateral to the rectus muscle that was communicating with the interfacial planes, around 3-4 cm from the tract of the CAPD catheter [Figure 2].
Figure 1: CECT image shows interfacial cavity filled with fluid, small communication and contrast in the bowel.

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Figure 2: Intraoperative image shows a small button hole communication with the interfacial spaces.

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Her CAPD catheter was removed subsequently two weeks after the kidney transplant. Dialysate leakage represents a major noninfectious complication of peritoneal dialysis (PD). The spectrum of dialysate leaks includes any dialysate loss from the peritoneal cavity other than via the lumen of the catheter. [3] An association has been found between early leaks (≤30 days) and immediate CAPD initiation and perhaps median catheter insertion. Late leaks may present more subtly with subcutaneous swelling and edema, weight gain, peripheral or genital edema and apparent ultrafiltration failure. [3] Catheter-related complications, including infection, dialysate leak, subcutaneous leak, outflow failure and malfunction are the principal causes of PD failure. [4] Dialysate leaks in CAPD are clinically important because they may cause fluid retention and a consequent decrease in fluid removal and clearance. [5] Our patient was slowly increasing the weight. Her dialysate was leaking in the abdominal wall interfacial-enclosed cavity and hence her dialysis was ineffective.

Conflict of interest: None declared.

 
   References Top

1.
Chan HM, Hsieh JS, Huang CJ, et al. Abdominal wall hernia complicating continuous ambulatory peritoneal dialysis. Gaoxiong Yi Xue Ke Xue Za Zhi 1994;10:444-8.  Back to cited text no. 1
    
2.
von Lilien T, Salusky IB, Yap HK, Fonkalsrud EW, Fine RN. Hernias: A frequent complication in children treated with continuous peritoneal dialysis. Am J Kidney Dis 1987; 10:356-60.  Back to cited text no. 2
    
3.
Leblanc M, Ouimet D, Pichette V. Dialysate leaks in peritoneal dialysis. Semin Dial 2001; 14:50-4.  Back to cited text no. 3
    
4.
Dönmez O, Durmaz O, Ediz B, Cigerdelen N, Kocak S. Catheter-related complications in children on chronic peritoneal dialysis. Adv Perit Dial 2005;21:200-3.  Back to cited text no. 4
    
5.
Ceri M, Altay M, Unverdi S, Kurultak I, Duranay M. An unusual presentation of vaginal leakage in a peritoneal dialysis patient. Perit Dial Int 2010;30:663-5.  Back to cited text no. 5
[PUBMED]    

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Correspondence Address:
Dr. Sanjay Gogoi
Department of Urology and Renal Transplant, Fortis Memorial Research Institute, Gurgaon, Haryana
India
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DOI: 10.4103/1319-2442.168693

PMID: 26586078

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  [Figure 1], [Figure 2]



 

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