CASE SNIPPETS Dr Rajasekhar 2nd year post graduate Department of Nephrology Gandhi Medical College

CASE DETAILS 56 Y/Male patient Non DM, Non HTN K/c/o CKD G5(D) On CAPD since 2017 Complaints of Paraumbilical swelling progressively increasing in size since 1 month. Loss of CAPD catheter function since 1 month. Serum creatinine is 12mg/dl at presentation

Case details …… P/A : Soft , non tender, swelling of 5x5 cms located in the left paraumbilical region , with no signs of inflammation over the swelling. Catheter exit site: Turbid fluid in the catheter exit site.

On evaluation: USG ABDOMEN : 6 × 4 On evaluation: USG ABDOMEN : 6 × 4.5 cms cystic collection in left paraumbilical region. CT ABDOMEN : Well defined hypodense fluid attenuating collection with thin septal and few air pockets noted intraperitoneally in left paraumbilic region extending upto left hypochondriac region causing mass effect in the form of compressing on adjacent bowel loops.

CT ABDOMEN

Contd…… A cystocath was placed and the cyst was drained. In view of the non functioning of the catheter: it was removed. Cultures of the PD fluid yielded no organism. The patient came for follow up after 2 weeks and repeat ultrasound was normal.

In our patient Painless progressively increasing swelling Non functioning CAPD catheter No symptoms/signs of bowel obstruction

Cystic complication in a patient on CAPD Abdominal pseudocyst in CAPD

LITERATURE Rare 1-4% incidence in VP shunts Occurs following peritonitis episodes loss of function: Compression by cyst Only 6 cases reported till now Pathogenesis : unknown DD : EPS

Contd……. Abdominal pseudocysts following peritoneal dialysis – associated peritonitis : A report of 3 cases.( AJKD 2010). Intraperitoneal pseudocyst formation: a complication of fungal peritonitis in CAPD.

CASE 2

Case details A 22 years old lady known CKD on MHD since 6 years and with H/O of secondary AV fistula failures , came for permanent access, the patient was planned temporarily for tunneled perm catheter and so a doppler of neck vessels was done

Case details ……. Doppler of neck vessels : Right IJV : Evidence of small segmental thrombus noted along the central line cathetre in the proximal Right IJV without causing significant stenosis. Left IJV :Relatively less calibre with normal colour uptake normal flow and normal spectral pattern.

Case details…….. The patient was planned for left perm catheter , left IJV was cannulated with good flow , but guidewire could not be passed , so a contrast was given and

Contd……. Repeat vascular evaluation before placing permcaths may be useful Definitive way of assessing patency is : angiogram Preferable to place right side permcaths under C-ARM so that the patency is confirmed. Thorough vascular access evaluation with doppler and angiogram may be needed in those with vascular access constraints.

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