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August 2006 Aseptic peritonitis in a peritoneal dialysis patient
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Nefrología (English Edition)
ISSN: 2013-2514

Nefrología is the official publication of the Spanish Society of Nephrology. The Journal publishes articles on basic or clinical research relating to nephrology, arterial hypertension, dialysis and kidney transplants. It is governed by the peer review system and all original papers are subject to internal assessment and external reviews. The journal accepts submissions of articles in English and in Spanish languages. Nefrología follows the publication requirements of the International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics (COPE).

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Vol. 26. Issue. 4.August 2006
Pages 415-524
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Vol. 26. Issue. 4.August 2006
Pages 415-524
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Aseptic peritonitis in a peritoneal dialysis patient
ASEPTIC PERITONITIS IN A PERITONEAL DIALYSIS PATIENT
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P. Pessegueiro, M. Amoedo, S. Barros, J. Aniceto y C. Pires
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Introducción: Los pacientes que presentan un cultivo bacteriano de líquido peritoneal repetidamente estéril, a pesar de un número de leucocitos elevado, deberán ser excluidas otras causas y no solo la peritonitis bacteriana. La patología intra-abdominal es responsable por lo menos de 6% de los casos de peritonitis, ya que el cuadro clínico en estas situaciones es mucho más grave de lo que en otras etiologías más comunes. Caso clínico: Paciente de 25 años, sexo masculino, no diabético, que inicia cuadro clínico de dolor abdominal difuso con remisiones y agravamientos espontáneos, anorexia y vómitos con 3 días de evolución. Cultivos bacteriológicos persistentemente negativos sugieren el diagnóstico de peritonitis aséptica. Incluso, considerando la evolución clínica y los niveles de amilasa en el fluido peritoneal >50UI/L, el paciente fue sometido a ecografía abdominal, la cual mostró una estructura tubular en la base del ciego, dolorosa e incomprensible, con un diámetro superior a 6 mm. Se procedió a laparotomía abdominal con extirpación del apéndice. Discusión: Considerando un paciente en diálisis peritoneal con dolor abdominal, líquido de drenaje turbio más estéril, deberán ser excluidas otras causas que no son peritonitis. Sobre un tratamiento antibiótico empírico, orientado para una peritonitis bacteriana, la evolución clínica de patologías viscerales abdominales podrá ser enmascarada, atrasando la resolución quirúrgica. En la apendicitis, este atraso lleva frecuentemente a la perforación y consecuentemente a la peritonitis fecal. El hecho de controlar los niveles de amilasa en el fluido peritoneal permite diferenciar la peritonitis bacteriana de la patología visceral abdominal. Un US/TAC abdominal debe ser practicado en situaciones de este tipo sin falta ni demora.
Introduction: Patients who have repeatedly sterile peritoneal fluid cultures despite elevated peritoneal fluid white cell count should be evaluated for disorders other than usual bacterial peritonitis. Intra-abdominal pathology was responsible for less than 6 percent of cases of peritonitis. Still, the clinical outcome is these situations are much worse than in other commoner causes. Case report: A 25-year-old male non-diabetic patient in PD started his complains with diffuse abdominal pain with spontaneous remissions and exacerbations, anorexia and vomiting with 3 days evolution. Laboratory results with persistent culture- negative peritoneal fluid results seemed compatible with the diagnosis of aseptic peritonitis. However, clinical status progression and peritoneal fluid amylase levels above 50UI/L led to perform an abdominal ultrasound that showed a painful non-compressible tubular structure with a diameter of > 6 mm at the base of the cecum. The patient was then submitted to a laparotomy with appendix removal. Discussion: When assessing a patient with abdominal pain and clear or cloudy but aseptic peritoneal liquid, causes other than peritonitis should be excluded. Under antibiotic therapy, their clinical picture and evolution may be masked, delaying surgical resolution. In appendicitis, this delay may lead to perforation and consequent faecal peritonitis. All patients should be screened for peritoneal fluid amylase levels in order to differentiate bacterial peritonitis from intra-abdominal pathology. In all cases similar to the present one, an abdominal US/CAT scan should be promptly made.


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