Computerized Tomography CT in the Diagnosis of Subcutaneous Leak Sites during Continuous Ambulatory Peritoneal Dialysis (CAPD)

Two patients receiving continuous ambulatory peritoneal dialysis (CAPD) presented with abdominal, and scrotal or vulvar edema. In both we suspected a dialysate leak, but the leak site could not be defined clinically. In one patient, a plain CT scan (without contrast in dialysate) revealed a small inguinal hernia and ruled out a pericatheter leak. In the other patient the route of fluid leakage could not be detected on a plain CT scan, or when images were taken immediately after contrast injection into dialysate, while the patient remained in the supine position on the CT table. Images taken two hours after contrast injection, with the patient ambulatory in the meantime, disclosed a leak through the tunnel of a previous peritoneal catheter. The diagnosis was confirmed at operation in both patients. Our experience suggests that when the diagnosis cannot be established clinically, CT scan may be useful to delineate a leak site.