Laparoscopic therapy in a CAPD patient with perforated appendicitis without removal of the peritoneal catheter

Peritonitis is the most common complication in patients receiving chronic ambulatory peritoneal dialysis (CAPD). It is normally readily diagnosed and successfully treated conservatively without serious complications. However, when peritonitis is resistant to standard intraperitoneal antibiotic therapy, underlying intra-abdominal pathology should be suspected [1]. Of all peritonitis in CAPD patients, 6–9% is caused by (multiple) enteric micro-organisms suggestive of gastrointestinal perforation [2]. It is often necessary to perform surgical exploration to confirm such a diagnosis [2,3]. A laparoscopic approach with these patients is gaining popularity as an alternative to open surgery. Finding a bowel perforation often means conversion to laparotomy and (long-term) cessation of PD because the CAPD catheter is removed. The idea behind this strategy is that foreign bodies should always be removed from infected areas. We present a case of a perforated appendicitis in a CAPD patient, diagnosed and treated laparoscopically, without loss of the peritoneal catheter.