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Mesenteric ischemia masquerading as refractory peritonitis in continuous ambulatory peritoneal dialysis patients.

Vishwakarma K, Anandh U - Indian J Nephrol (2015 Nov-Dec)

Bottom Line: On evaluation of refractory peritonitis we found evidence of non occlusive mesenteric ischemia.Despite adequate treatment both succumbed to their illness.Abdominal pathology, especially mesenteric ischemia leading to gut infarction, should be considered in patients with refractory peritonitis.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, SGPGI, Lucknow, Uttar Pradesh, India.

ABSTRACT
We report two cases of mesenteric ischemia in patients on long term peritoneal dialysis both of which were associated with poor outcomes. Both were diabetic and on peritoneal dialysis for a long time. On evaluation of refractory peritonitis we found evidence of non occlusive mesenteric ischemia. Despite adequate treatment both succumbed to their illness. Abdominal pathology, especially mesenteric ischemia leading to gut infarction, should be considered in patients with refractory peritonitis.

No MeSH data available.


Related in: MedlinePlus

Computed tomography scan of the abdomen showing thumbprinting suggestive of mesenteric ischemia
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Figure 2: Computed tomography scan of the abdomen showing thumbprinting suggestive of mesenteric ischemia

Mentions: A 70-year-old male, known case of diabetes mellitus, hypertension, CKD stage 5 on CAPD for last 5 years, was admitted with low-grade fever, vomiting, and drowsiness. On evaluation, he was febrile and icteric. He was in altered sensorium with no obvious deficit. His abdominal examination revealed a distended tender abdomen. His initial laboratory investigations are given in Table 1. A diagnosis of CAPD peritonitis with sepsis was made, and he was started on antibiotics. His peritoneal fluid assay showed evidence of culture negative peritonitis. Despite the treatment, he showed minimal improvement. After 2 days, he developed hypotension and breathlessness. His blood culture sent on admission showed growth of Enterococcus faecium. He was intubated, ventilated and started on meropenem and tigecycline. A CT scan of the abdomen was done, which showed diffuse thickening of small bowel loop predominantly in the jejunum with thumb printing appearance [Figure 2]. There was no enhancement of the jejunal loops on contrast administration suggestive of ischemic bowel disease. Celiac and superior mesenteric arteries appeared small in caliber along with diffuse atherosclerotic changes in CT angiography. There was no evidence of thrombotic occlusion of the artery. Peripheral nonenhancing areas were seen in spleen suggestive of splenic infarcts. These changes progressively worsened on repeat scan and patient rapidly deteriorated. He was managed conservatively keeping in view of his poor general condition and advanced comorbidities, and he expired after 2 days.


Mesenteric ischemia masquerading as refractory peritonitis in continuous ambulatory peritoneal dialysis patients.

Vishwakarma K, Anandh U - Indian J Nephrol (2015 Nov-Dec)

Computed tomography scan of the abdomen showing thumbprinting suggestive of mesenteric ischemia
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663779&req=5

Figure 2: Computed tomography scan of the abdomen showing thumbprinting suggestive of mesenteric ischemia
Mentions: A 70-year-old male, known case of diabetes mellitus, hypertension, CKD stage 5 on CAPD for last 5 years, was admitted with low-grade fever, vomiting, and drowsiness. On evaluation, he was febrile and icteric. He was in altered sensorium with no obvious deficit. His abdominal examination revealed a distended tender abdomen. His initial laboratory investigations are given in Table 1. A diagnosis of CAPD peritonitis with sepsis was made, and he was started on antibiotics. His peritoneal fluid assay showed evidence of culture negative peritonitis. Despite the treatment, he showed minimal improvement. After 2 days, he developed hypotension and breathlessness. His blood culture sent on admission showed growth of Enterococcus faecium. He was intubated, ventilated and started on meropenem and tigecycline. A CT scan of the abdomen was done, which showed diffuse thickening of small bowel loop predominantly in the jejunum with thumb printing appearance [Figure 2]. There was no enhancement of the jejunal loops on contrast administration suggestive of ischemic bowel disease. Celiac and superior mesenteric arteries appeared small in caliber along with diffuse atherosclerotic changes in CT angiography. There was no evidence of thrombotic occlusion of the artery. Peripheral nonenhancing areas were seen in spleen suggestive of splenic infarcts. These changes progressively worsened on repeat scan and patient rapidly deteriorated. He was managed conservatively keeping in view of his poor general condition and advanced comorbidities, and he expired after 2 days.

Bottom Line: On evaluation of refractory peritonitis we found evidence of non occlusive mesenteric ischemia.Despite adequate treatment both succumbed to their illness.Abdominal pathology, especially mesenteric ischemia leading to gut infarction, should be considered in patients with refractory peritonitis.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, SGPGI, Lucknow, Uttar Pradesh, India.

ABSTRACT
We report two cases of mesenteric ischemia in patients on long term peritoneal dialysis both of which were associated with poor outcomes. Both were diabetic and on peritoneal dialysis for a long time. On evaluation of refractory peritonitis we found evidence of non occlusive mesenteric ischemia. Despite adequate treatment both succumbed to their illness. Abdominal pathology, especially mesenteric ischemia leading to gut infarction, should be considered in patients with refractory peritonitis.

No MeSH data available.


Related in: MedlinePlus