|Year : 2020 | Volume
| Issue : 1 | Page : 34-35
An unusual complication of CAPD technique: Lesson to be learnt
Muzamil Ahmed1, Manjusha Yadla2
1 Senior Resident, Gandhi Medical College, Hyderabad, Telangana, India
2 Department of Nephrology, Gandhi Medical College, Hyderabad, Telangana, India
|Date of Submission||03-Jun-2019|
|Date of Decision||20-Apr-2020|
|Date of Acceptance||14-May-2020|
|Date of Web Publication||31-Dec-2020|
Dr. Manjusha Yadla
Department of Nephrology, Gandhi Medical College, Hyderabad, Telangana
Source of Support: None, Conflict of Interest: None
Continuous Ambulatory Peritoneal Dialysis is a recommended mode of renal replacement therapy in those with vascular access failures. Complications of Surgical placement of catheter and Percutaneous technique by Nephrologist are well described. Complications may occur during the procedure or after the procedure. During the placement of the catheter, hollow viscus perforation is known to occur. Patients are given instructions of using laxative , emptying bladder before surgery in order to avoid bladder or bowel injury. Bladder perforation is one of the rare complication of CAPD technique.It is expected to occur commonly with rigid catheters than the soft catheters used in CAPD. Herein we report a case of bladder perforation during the procedure of placement of percutaneous CAPD catheterization.
CAPD, bladder perforation, percutaneous
|How to cite this article:|
Ahmed M, Yadla M. An unusual complication of CAPD technique: Lesson to be learnt. Indian J Perit Dial 2020;38:34-5
| Introduction|| |
Bladder perforation is rare complication of present day CAPD techniques. Nevertheless, it is prudent that both bladder is emptied before CAPD catheter insertion. Herein, we present a case of bladder perforation during CAPD procedure.
| Case Report|| |
A 35-year aged woman, P1L1, is admitted for placement of CAPD catheter. She was given the regular instructions of prophylactic antibiotic, laxative usage, betadine scrub of the operating area. She underwent CAPD catheterization with double cuffed Tenckhoff catheter. Flush Xray KUB was done to check the position of tip of the catheter [Figure 1]. Catheter tip was in pelvis though the course of the catheter was not normal. Six hour later, she complained of hematuria and the next morning she had increase in urine output. Ultrasound abdomen showed CAPD catheter in the urinary bladder [Figure 1]. Contrast CT Cystography was done to evaluate for intraperitoneal or extraperitoneal perforation. On CT contrast there was no evidence of peritoneal communication [Figure 1]. An intraperitoneal communication was ruled out.Patient was placed on per urethral catheter. CAPD catheter was removed. She was discharged with perurethral catheter. She was subsequently placed on another CAPD catheter after 4 weeks which was uneventful.
|Figure 1: Upper left panel showing horizontally located PD catheter on X-ray kidney ureter and bladder (KUB). Upper right panel showing catheter in urinary bladder on ultrasound. Lower left panel showing catheter in urinary bladder on computed tomography Cystography. Lower left panel showing no evidence of seepage of contrast into peritoneum post contrast|
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| Discussion|| |
Bladder Perforation is rare complication during the procedure of CAPD catheter placement. There are very few cases reported in literature. First such case of inadvertent placement was reported by Moreiras etal in 54 year old patient, during percutaneous technique. Similar cases were reported by Ounissi etal, Bamberger etal where in bladder perfotration was observed with in 2 weeks or after the initiation of regular exchanges.
Our patient is not a known case of neurogenic baldder and she had urine output of 200ml during the admission. In addition, she emptied the bladder before the procedure.In our unit, before placement of soft catheter, a rigid peritoneal catheter is placed and checked for inflow and outflow. If a good in and outflows are present, then the soft catheter is placed. This is a cost effective measure to avoid wastage of CAPD catheter, if encountered with complications during the placement. After placement of rigid catheter the inflow and outflow were normal and there was no urge to pass urine.Six hours later there was an increase in urine ouput .A sudden increase in urine output after placement of CAPD catheter should prompt the evaluation for bladder perforation.
Placement of CAPD catheter under imaging may be suggested to avoid inadvertent complications like bladder perforation. Emphasis was laid on emptying the bladder before surgery by the patient or catheterization of bladder in case of neurogenic bladder diabetic patient with autonomic neuropathy and in those with peritoneal adhesions.
Points of interest
- If Percutaneous placement of CAPD catheter is being done bedside, catheterization of bladder before the placement would be .beneficial in patients with suspected urinary bladder dysfunction
- An increase in urine amount following the CAPD catheter placement should prompt the evaluation for bladder perforation.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Moreiras M, Cuiña L, Rguez Goyanes G, Sobrado JA, Gil P. Inadvertent placement of a tenckhoff catheter into the urinary bladder. Nephrol Dial Transpl 1997;12:818-20.
Ounissi M, Sfaxi M, Fayala H, Abderrahim E, Abdallah TB, Chebil M, et al
. Bladder perforation in a peritoneal dialysis patient. Saudi J Kidney Dis Transpl 2012;23:552-5. [Full text]