Late peritoneal leakage due to an abdominal wall defect: report of a rare complication.

Abstract

Dialysate leakage is a complication of peritoneal dialysis with a 5% incidence rate. Late leaks are rare, and symptoms are subtle, as fluid loss occurs most often through abdominal wall defects.

An 83-year-old diabetic woman was started on automated peritoneal dialysis one month after catheter placement. Three years later, the patient complained of tiredness, peripheral edema, and abdominal pressure. Inspection showed local erythema and orange-peel skin. A computed tomography scan showed periumbilical drainage, suggesting a peritoneal leak. The patient was referred for surgery, which found a 5 mm aponeurotic defect; a herniorrhaphy was performed. The patient resumed her usual treatments without further complications.

Dialysate leaks may lead to discontinuation of peritoneal dialysis. The clinical presentation can be insidious, as in this case. Active surveillance was pursued, and the patient was managed without the need for temporary switching to hemodialysis.