Endoscopic Management of Delayed Perforation of the Rectum Caused by a Peritoneal Dialysis Catheter

Abstract

Bowel perforation caused by a peritoneal dialysis (PD) catheter is an uncommon complication. It occurs mostly at the time of insertion of a catheter. Delayed perforation of the bowel by a PD catheter can also occur, but is even more uncommon. The ideal management of perforation of the colon by a PD catheter remains to be established because of its very low incidence. Definite surgery is the usual treatment. Here, we report on a 50-year-old male patient who presented with severe watery diarrhea owing to delayed rectal perforation caused by a PD catheter. A computed tomography scan revealed that the catheter tip was inside the lumen of the rectum. This was further confirmed by colonoscopy after bowel preparation. The PD catheter was removed via the original abdominal incision and the rectal perforation was closed using 3 endoscopic clips. The patient made an uneventful recovery. Key Words: peritoneal dialysis (PD), bowel perforation, peritoneal dialysis catheter, Endoscopic management (Surg Laparosc Endosc Percutan Tech 2011;21:e44–e47) Bowel perforation caused by a peritoneal dialysis (PD) catheter occurs very rarely, but has serious consequences. 1 Such perforations mostly occur during catheter insertion; however, delayed perforation can also occur some time after catheter insertion.2,3 Although the treatment of bowel perforations usually involves definitive surgery,1 the optimal treatment approach has not been established yet. The present report describes a case of delayed rectal perforation caused by a PD catheter that was successfully treated using endoscopic methods and endoclips.