Bowel Erosion Due to a Dormant Peritoneal Catheter in Immunosuppressed Renal Transplant Recipients

Continuous ambulatory peritoneal dialysis (CAPD) patients are not considered to be at increased risk of infection after transplantation when compared to other renal transplant recipients. This article describes two patients who developed bowel erosion and life-threatening peritonitis following irritation from a dormant, indwelling peritoneal catheter. In both cases, the classical signs of peritonitis were masked by immunosuppressive therapy. In one patient, the catheter was removed, but she died of fecal peritonitis and sepsis. The second patient, who was taken to the operating room for laparotomy once peritonitis was diagnosed, survived; he required segmental resection and appendectomy because of multiple bowel erosions. As a result of this experience, we suggest that the peritoneal catheter be removed as early as possible after transplantation once renal function has been established. Furthermore, we believe that peritonitis developing in patients with dormant indwelling peritoneal dialysis catheters should have a prompt exploratory laparotomy to rule out perforation, because in an immunosuppressed host this condition may be rapidly fatal.