Early peritoneal-scrotal leakage in a patient submitted to peritoneal dialysis demonstrated by dynamic peritoneal 99mTc-phytate scintigraphy

A 77 year old male with history of renal lithiasis leading to right nefrectomy and end stage renal disease (ESRD) secondary to possible vascular nephropathy and focal segmental glomerulosclerosis diagnosed in 2009, started ambulatory peritoneal dialysis (APD) due to clinical decline. Insufficient drainage of the peritoneal dialysis solution with progressive bilateral testicular edema (more severe in right side) was observed from the first APD session. As a consequence, the patient needed temporarily hemodialysis. In order to diagnose a patent peritoneal-vaginal duct, a dynamic 99mTc-Phytate scintigraphy was performed after introduction of peritoneal dialysis solution (600, 1200 and 2000 mL) labelled with 74 MBq of 99mTc-Phytate in the abdominal cavity. A total of 60 images (30 seconds per image) were acquired and a hypogastric uptake of radiotracer was observed (Figure 1 Panel a). Right inguinal and scrotal uptake was observed only after per-