Gangrenous appendicitis presenting as acute abdominal pain in a patient on automated peritoneal dialysis: a case report
<p>Abstract</p> <p>Introduction</p> <p>Presentations of abdominal pain in patients on peritoneal dialysis deserve maximal attention and careful differential diagnosis on admittance to medical care. In this case report a gangrenous appendicitis in a patient on automated...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2012-09-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | http://www.jmedicalcasereports.com/content/6/1/309 |
| _version_ | 1818066275954327552 |
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| author | Ekart Robert Horvat Matjaž Koželj Miran Balon Breda Bevc Sebastjan Hojs Radovan |
| author_facet | Ekart Robert Horvat Matjaž Koželj Miran Balon Breda Bevc Sebastjan Hojs Radovan |
| author_sort | Ekart Robert |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Introduction</p> <p>Presentations of abdominal pain in patients on peritoneal dialysis deserve maximal attention and careful differential diagnosis on admittance to medical care. In this case report a gangrenous appendicitis in a patient on automated peritoneal dialysis is presented.</p> <p>Case presentation</p> <p>We report the case of a 38-year-old Caucasian man with end-stage renal disease who was on automated peritoneal dialysis and developed acute abdominal pain and cloudy peritoneal dialysate. Negative microbiological cultures of the peritoneal dialysis fluid and an abdominal ultrasonography misleadingly led to a diagnosis of culture negative peritonitis. It was decided to remove the peritoneal catheter but the clinical situation of the patient did not improve. An explorative laparotomy was then carried out; diffuse peritonitis and gangrenous appendicitis were found. An appendectomy was performed. Myocardial infarction and sepsis developed, and the outcome was fatal.</p> <p>Conclusion</p> <p>A peritoneal dialysis patient with abdominal pain that persists for more than 48 hours after the usual antibiotic protocol for peritoneal dialysis-related peritonitis should immediately alert the physician to the possibility of peritonitis caused by intra-abdominal pathology. Not only peritoneal catheter removal is indicated in patients whose clinical features worsen or fail to resolve with the established intra-peritoneal antibiotic therapy but, after 72 hours, an early laparoscopy should be done and in a case of correct indication (intra-abdominal pathology) an early explorative laparotomy.</p> |
| first_indexed | 2024-12-10T15:05:12Z |
| format | Article |
| id | doaj.art-2daf81973676412e9260ac93848b4671 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-12-10T15:05:12Z |
| publishDate | 2012-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-2daf81973676412e9260ac93848b46712022-12-22T01:44:04ZengBMCJournal of Medical Case Reports1752-19472012-09-016130910.1186/1752-1947-6-309Gangrenous appendicitis presenting as acute abdominal pain in a patient on automated peritoneal dialysis: a case reportEkart RobertHorvat MatjažKoželj MiranBalon BredaBevc SebastjanHojs Radovan<p>Abstract</p> <p>Introduction</p> <p>Presentations of abdominal pain in patients on peritoneal dialysis deserve maximal attention and careful differential diagnosis on admittance to medical care. In this case report a gangrenous appendicitis in a patient on automated peritoneal dialysis is presented.</p> <p>Case presentation</p> <p>We report the case of a 38-year-old Caucasian man with end-stage renal disease who was on automated peritoneal dialysis and developed acute abdominal pain and cloudy peritoneal dialysate. Negative microbiological cultures of the peritoneal dialysis fluid and an abdominal ultrasonography misleadingly led to a diagnosis of culture negative peritonitis. It was decided to remove the peritoneal catheter but the clinical situation of the patient did not improve. An explorative laparotomy was then carried out; diffuse peritonitis and gangrenous appendicitis were found. An appendectomy was performed. Myocardial infarction and sepsis developed, and the outcome was fatal.</p> <p>Conclusion</p> <p>A peritoneal dialysis patient with abdominal pain that persists for more than 48 hours after the usual antibiotic protocol for peritoneal dialysis-related peritonitis should immediately alert the physician to the possibility of peritonitis caused by intra-abdominal pathology. Not only peritoneal catheter removal is indicated in patients whose clinical features worsen or fail to resolve with the established intra-peritoneal antibiotic therapy but, after 72 hours, an early laparoscopy should be done and in a case of correct indication (intra-abdominal pathology) an early explorative laparotomy.</p>http://www.jmedicalcasereports.com/content/6/1/309Abdominal painAppendicitisMyocardial infarctionPeritoneal dialysis |
| spellingShingle | Ekart Robert Horvat Matjaž Koželj Miran Balon Breda Bevc Sebastjan Hojs Radovan Gangrenous appendicitis presenting as acute abdominal pain in a patient on automated peritoneal dialysis: a case report Journal of Medical Case Reports Abdominal pain Appendicitis Myocardial infarction Peritoneal dialysis |
| title | Gangrenous appendicitis presenting as acute abdominal pain in a patient on automated peritoneal dialysis: a case report |
| title_full | Gangrenous appendicitis presenting as acute abdominal pain in a patient on automated peritoneal dialysis: a case report |
| title_fullStr | Gangrenous appendicitis presenting as acute abdominal pain in a patient on automated peritoneal dialysis: a case report |
| title_full_unstemmed | Gangrenous appendicitis presenting as acute abdominal pain in a patient on automated peritoneal dialysis: a case report |
| title_short | Gangrenous appendicitis presenting as acute abdominal pain in a patient on automated peritoneal dialysis: a case report |
| title_sort | gangrenous appendicitis presenting as acute abdominal pain in a patient on automated peritoneal dialysis a case report |
| topic | Abdominal pain Appendicitis Myocardial infarction Peritoneal dialysis |
| url | http://www.jmedicalcasereports.com/content/6/1/309 |
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