Aseptic peritonitis in a peritoneal dialysis patient.

INTRODUCTION: Patients who have repeatedly sterile peritoneal fluid cultures despite elevated peritoneal fluid white cell count should be evaluated for disorders other than usual bacterial peritonitis. Intra-abdominal pathology was responsible for less than 6 percent of cases of peritonitis. Still, the clinical outcome is these situations are much worse than in other commoner causes. CASE REPORT: A 25-year-old male non-diabetic patient in PD started his complains with diffuse abdominal pain with spontaneous remissions and exacerbations, anorexia and vomiting with 3 days evolution. Laboratory results with persistent culture-negative peritoneal fluid results seemed compatible with the diagnosis of aseptic peritonitis. However, clinical status progression and peritoneal fluid amylase levels above 50 UI/L led to perform an abdominal ultrasound that showed a painful non-compressible tubular structure with a diameter of >6 mm at the base of the cecum. The patient was then submitted to a laparotomy with appendix removal. DISCUSSION: When assessing a patient with abdominal pain and clear or cloudy but aseptic peritoneal liquid, causes other than peritonitis should be excluded. Under antibiotic therapy, their clinical picture and evolution may be masked, delaying surgical resolution. In appendicitis, this delay may lead to perforation and consequent faecal peritonitis. All patients should be screened for peritoneal fluid amylase levels in order to differentiate bacterial peritonitis from intra-abdominal pathology. In all cases similar to the present one, an abdominal US/CAT scan should be promptly made.

Aseptic peritonitis in a peritoneal dialysis patient

Introducción: Los pacientes que presentan un cultivo bacteriano de líquido peritonealrepetidamente estéril, a pesar de un número de leucocitos elevado, deberánser excluidas otras causas y no solo la peritonitis bacteriana. La patologíaintra-abdominal es responsable por lo menos de 6% de los casos de peritonitis,ya que el cuadro clínico en estas situaciones es mucho más grave de lo que enotras etiologías más comunes. Caso clínico: Paciente de 25 años, sexo masculino, no diabético, que inicia cuadroclínico de dolor abdominal difuso con remisiones y agravamientos espontáneos,anorexia y vómitos con 3 días de evolución. Cultivos bacteriológicos persistentementenegativos sugieren el diagnóstico de peritonitis aséptica. Incluso, considerando la evoluciónclínica y los niveles de amilasa en el fluido peritoneal >50UI/L, el paciente fuesometido a ecografía abdominal, la cual mostró una estructura tubular en la base delciego, dolorosa e incomprensible, con un diámetro superior a 6 mm. Se procedió alaparotomía abdominal con extirpación del apéndice.Discusión: Considerando un paciente en diálisis peritoneal con dolor abdominal,líquido de drenaje turbio más estéril, deberán ser excluidas otras causas queno son peritonitis. Sobre un tratamiento antibiótico empírico, orientado para unaperitonitis bacteriana, la evolución clínica de patologías viscerales abdominalespodrá ser enmascarada, atrasando la resolución quirúrgica. En la apendicitis, esteatraso lleva frecuentemente a la perforación y consecuentemente a la peritonitisfecal. El hecho de controlar los niveles de amilasa en el fluido peritoneal permitediferenciar la peritonitis bacteriana de la patología visceral abdominal. Un US/TACabdominal debe ser practicado en situaciones de este tipo sin falta ni demora

Introduction: Patients who have repeatedly sterile peritoneal fluid cultures despiteelevated peritoneal fluid white cell count should be evaluated for disordersother than usual bacterial peritonitis. Intra-abdominal pathology was responsiblefor less than 6 percent of cases of peritonitis. Still, the clinical outcome is thesesituations are much worse than in other commoner causes.Case report: A 25-year-old male non-diabetic patient in PD started his complainswith diffuse abdominal pain with spontaneous remissions and exacerbations,anorexia and vomiting with 3 days evolution. Laboratory results with persistent culture-negative peritoneal fluid results seemed compatible with the diagnosis of asepticperitonitis. However, clinical status progression and peritoneal fluid amylase levelsabove 50UI/L led to perform an abdominal ultrasound that showed a painfulnon-compressible tubular structure with a diameter of > 6 mm at the base of thececum. The patient was then submitted to a laparotomy with appendix removal.Discussion: When assessing a patient with abdominal pain and clear or cloudybut aseptic peritoneal liquid, causes other than peritonitis should be excluded.Under antibiotic therapy, their clinical picture and evolution may be masked, delayingsurgical resolution. In appendicitis, this delay may lead to perforation andconsequent faecal peritonitis. All patients should be screened for peritoneal fluidamylase levels in order to differentiate bacterial peritonitis from intra-abdominalpathology. In all cases similar to the present one, an abdominal US/CAT scanshould be promptly made