Two tunnels for one peritoneal dialysis catheter: a case for caution

Description

Catheter tunnel infection (CTI) is a known cause of adverse outcomes in peritoneal dialysis (PD)-related peritonitis. Extension of exit site infection is the most common reported reason for CTI. We report a case of PD-related peritonitis due to a delayed surgical complication.

A man aged 54 years with a history of end-stage renal disease due to polycystic kidney disease, on continuous cycling PD for the past 5 years, presented with fever, abdominal pain and cloudy PD effluent. His abdomen was diffusely tender. Except for extruded external cuff, the PD catheter exit site was unremarkable. Serous drainage was noted 1 inch from the exit site where the surgical trocar had been inserted for laparoscopic PD catheter placement. The patient reported increasing drainage for 4 weeks prior to presentation. Laboratory studies were consistent with PD-related peritonitis with PD fluid white cell count of 470/mm³ and 64% neutrophils. Broad-spectrum antibiotics were initiated. The...

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