A rare case of peritonitis complicating acute appendicitis in a Patient on peritoneal dialysis

Abstract

Peritonitis is the most common complication in patients undergoing peritoneal dialysis (PD). However, its persistence despite appropriate antibiotic therapy should prompt consideration of alternative diagnoses, particularly acute appendicitis. We report the case of a 39-year-old PD patient who presented with culture-negative peritonitis unresponsive to treatment, ultimately resulting in a diagnosis of latero-cecal acute appendicitis. Diagnosis was confirmed by abdominal CT scan and exploratory laparoscopy, leading to surgical management with appendectomy and peritoneal lavage, while the catheter was preserved. Clinical improvement was achieved with targeted antibiotic therapy, and PD was resumed with low-volume exchanges without switching to hemodialysis. This case highlights the diagnostic challenge of acute appendicitis in PD patients, where clinical signs can be masked by frequent peritoneal lavage and intraperitoneal antibiotics. Prompt imaging and early surgical intervention are crucial to prevent complications.