Persistent symptomatic intra-abdominal collection after catheter removal for PD-related peritonitis.

BACKGROUND Peritoneal dialysis (PD) patients with severe peritonitis require catheter removal. It is often assumed that this approach, together with antibiotics, would eradicate the infection; however, some patients continue to have problems despite catheter removal. METHOD We reviewed 30 consecutive PD patients in our center from 1997 to 2008 with recurrent loculated peritoneal collection after catheter removal for severe peritonitis. RESULTS Of the 1928 episodes of peritonitis that occurred in 702 patients during the study period, 11.1% required catheter removal and 1.6% developed recurrent peritoneal collection that required percutaneous drainage. Median time to diagnosis of intra-abdominal collection was 12 days after catheter removal (interquartile range 7 - 61 days). In 25 patients (83.3%), aspirate of the abdominal collection was culture negative. In 17 patients (56.7%), the abdominal collection was recurrent and required repeated percutaneous aspiration. Only 3 patients had successful reinsertion of the peritoneal catheter but all had reduced small solute clearance after returning to PD. CONCLUSION A small but not negligible proportion of patients with PD-related peritonitis develop recurrent intra-abdominal collection that requires percutaneous drainage after catheter removal. The chance of a successful return to PD is very low in this group of patients. Direct conversion to long-term hemodialysis may avoid unnecessary attempts at peritoneal catheter reinsertion.