Prevalence and outcome of abdominal wall hernia in patients with end-stage renal disease on peritoneal dialysis.

INTRODUCTION: We aimed to study the prevalence, risk factors, management, and outcome of hernias in end-stage renal disease (ESRD) patients on peritoneal dialysis (PD) from India. METHODS: This was a retrospective study of ESRD-PD patients who developed hernias over 11 years. RESULTS: Of 470 PD patients, 21 developed hernias (4.2%). Mean age of patients was 49.9 ± 15.36 years; 15 (66.66%) were males; 18 (85.71%) patients had umbilical hernia, 3 (14.28%) had inguinal hernia. Continuous ambulatory PD (CAPD) versus automated PD (APD) (OR: 11.623, 95% CI: 2.060-65.581, p = 0.005) was the independent risk factor identified. Incarcerated umbilical/inguinal hernia was managed surgically (6 [28.57%]); uncomplicated umbilical hernia (15 [71.42%]) managed conservatively (shift to (APD) [33.33%]; switch to low-volume APD [20%], switch to low-volume CAPD [46.66%]). None had postoperative hernia recurrences; 4 (19%) had PD technique failure; median PD survival was 36 (IQR 17-55) months. CONCLUSION: Although complicated hernias in PD require surgical repair, uncomplicated umbilical hernias can be managed conservatively by switching to APD/low-volume CAPD, with good long-term PD technique survival.

Cerebral abscess and calvarial osteomyelitis caused by Burkholderia pseudomallei in a renal transplant recipient.

Melioidosis is an infection of humans caused by the saprophytic bacterium Burkholderia (previously Pseudomonas) pseudomallei. We present a patient of cerebral abscess and calvarial osteomyelitis caused by B. pseudomallei in a renal transplant recipient. We treated the patient with ceftazidime for 3 weeks, followed by trimethoprim-sulfamethoxazole (TMP-SMX) for 6 months. The superficial abscess reduced in size at the end of first month and subsided gradually. A repeat MRI showed reduction in intracranial abscess. The patient had no neurological deficit.