Perforative Peritonitis caused by Appendicitis in a Patient on Peritoneal Dialysis

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Author(s)

    • Mizuno Masashi
    • Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Japan|Division of Nephrology, Nagoya University Graduate School of Medicine, Japan
    • Suzuki Yasuhiro
    • Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Japan|Division of Nephrology, Nagoya University Graduate School of Medicine, Japan
    • Nonaka Keisuke
    • Division of Nephrology, Nagoya University Graduate School of Medicine, Japan
    • Sei Yumi
    • Division of Nephrology, Nagoya University Graduate School of Medicine, Japan
    • Maruyama Shoichi
    • Division of Nephrology, Nagoya University Graduate School of Medicine, Japan
    • Matsuo Seiichi
    • Division of Nephrology, Nagoya University Graduate School of Medicine, Japan
    • Ito Yasuhiko
    • Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Japan|Division of Nephrology, Nagoya University Graduate School of Medicine, Japan

Abstract

A 46-year-old man on peritoneal dialysis (PD) was hospitalized due to suspicious PD-related peritonitis. Because the patient's abdominal pain was unimproved by conventional antibiotics and multiple bacteria were identified in a smear-sample of PD fluid, endogenous peritonitis was suspected. Perforated appendicitis was finally diagnosed under exploratory laparotomy. In this patient, perforated appendicitis was difficult to diagnose due to the attenuated clinical symptoms and inconclusive results of abdominal computed tomography (CT), even though the positive predictive value of CT is >95% in non-PD patients. Quickly deciding to perform exploratory laparotomy in patients suspected of having endogenous peritonitis is thus important, even when the origin has not been clarified.<br>

Journal

  • Internal Medicine

    Internal Medicine 52(11), 1177-1181, 2013

    The Japanese Society of Internal Medicine

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