Catheter leakage in a CAPD patient

Dialysate leakage is one of the most common and important complications in continuous ambulatory peritoneal dialysis (CAPD). However, there is limited discussion about the complications resulting from leakage of peritoneal effluent caused by a defect of the peritoneal catheter (i.e., a catheter break). We herein report on a uremic patient who received CAPD therapy for 2 years and was bothered with dialysate leakage and ensuing peritonitis. The location of leakage could not be resolved by Tc-99m MAA peritoneal scintigraphy or abdominal computed tomography. The peritoneal catheter was eventually removed, disclosing a large, irregular-edged hole (not indicative of having been trauma-induced) near the external cuff of the intercuff segment of the Tenckhoff catheter. The patient suffered from severe peritonitis with mixed pathogens, and the therapeutic response was poor. Our results suggest that once the CAPD patient is exposed to dialysate leakage and develops unresponsive peritonitis, early removal of the PD catheter should be mandatory in order to avoid a poor outcome.