Perforative peritonitis is a rare but fatal complication associated with significant mortality in peritoneal dialysis (PD). Clinical practice with antibiotics combine surgical intervention improves perforative peritonitis outcome. We report a case of PD-related Pseudomonas peritonitis under aggressive antibiotics, ileum perforation with turbid fluid leakage happened 3 days later after catheter removal. Exploratory laparotomy was arranged for small intestinal repair on day 17. However, progressive abdomen pain with massive turbid discharge 600 - 700 c.c./day from combination waste vent (CWV) drain was noted on day 30 (2 weeks after the small intestinal repair operation). Abdomen computed tomography reported residual lesser sac abscess with air-fluid collection and another capsulated abscess over midline lower pelvis. Leakage of anastomosis of small intestine with intra-abdominal abscess was diagnosed. Conservative treatment with negative pressure CWV drainage, antibiotic therapy, and total parenteral nutrition was performed for 3 weeks. Finally, the patient successful discharged under regular hemodialysis. Our case suggests that it is necessary to keep in mind the possibility of perforative peritonitis in PD patients with Pseudomonas peritonitis.
在腹膜透析病人中,腹膜炎是常見的感染併發症。穿孔性腹膜炎是少見但是會造成病人死亡的嚴重問題。臨床上有效的抗生素治療和及時的手術處理可以有效改善病人預後。我們報告一位腹膜透析綠膿桿菌腹膜炎的個案,雖然積極的抗生素治療和手術移除腹膜透析導管,在手術移除腹膜透析導管後第3天發生迴腸穿孔合併腹部手術傷口大量混濁液體滲漏。在住院第17天,緊急的腹腔鏡手術來修補迴腸穿孔腹膜炎。然而在腹腔鏡手術2星期後(住院第30天),持續的腹痛且每天大量混濁液體600-700 c.c.從引流管流出。腹部電腦斷層發現一個小網膜膿腫和另一個骨盆腔內的膿腫。臨床上診斷為迴腸穿孔手術傷口滲漏合併腹膜內膿腫。保守治療包含負壓引流、抗生性治療和全靜脈營養注射持續了3個星期。最後病人成功治癒出院轉到血液透析治療。我們的個案報告指出在腹膜透析綠膿桿菌腹膜炎病人中,需要非常注意穿孔性腹膜炎的併發症。