Bacterial peritonitis following endoscopic treatment of cecal vascular ectasia in a patient on ambulatory peritoneal dialysis

P. Pinto Marques¹, D. Carvalho²

 

Resumo

 A peritonite mantém-se uma complicação grave em doentes submetidos a diálise peritoneal, sendo uma causa importante de internamento, mortalidade e perda da viabilidade do catéter, implicando o recurso à hemodiálise. A colonoscopia poderá ser um factor de risco, presumivelmente por translocação bacteriana. As actuais recomendações sobre antibioterapia profilácica não especificam a abordagem neste subgrupo de doentes.

Caso clínico: Um doente de 57 anos sob diálise peritoneal desenvolveu um quadro de peritonite bacteriana após terapêutica endoscópica de uma angiodisplasia no cego com árgon plasma e injecção de adrenalina. Não se observou evidência imagiológica de perfuração. Foi instituída terapêutica antibiótica intra-peritoneal com sucesso.

Conclusão: Este caso sublinha a necessidade de remoção do liquido de diálise peritoneal associado à instituição prévia de antibioterapia profiláctica de largo espectro, antes da realização de terapêutica endoscópica no decurso de uma colonoscopia.

 

 

Summary

Background: Peritonitis remains a serious problem for patients on peritoneal dialysis, being a leading cause to admissions, mortality and catheter loss with need for

hemodialysis. Patients undergoing colonoscopy are at increased risk, presumably from bacteria translocation. Current guidelines for antibiotic prophylaxis don’t emphasise their need in this subset of patients.

Case Report: A 57-year-old man on continuous ambulatory peritoneal dialysis (CAPD) developed bacterial peritonitis following cecal vascular ectasia - endoscopic treatment with argon plasma coagulation and injection therapy. There was no imaging evidence for perforation. Successful treatment was achieved with intraperitoneal antibiotics.

Conclusion: The case underscores the need for emptying the peritoneal cavity of dialysate in peritoneal dialysis patients in association with large-spectrum antibiotic prophylaxis, before endoscopic treatment during colonoscopy.

 

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Bibliografia

 

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Correspondência:

Pedro Pinto Marques

Avenida Torrado da Silva

Serviço de Gastrenterologia

Hospital Garcia de Orta

2801-951 Almada, Portugal

Portugal

Tel.: (351) 212940294

Fax: (351) 212957004

e-mail: pedromarq@hotmail.com

 

(1) Gastroenterology Division, Internal Medicine Department, Hospital Garcia de Orta, Lisboa, Portugal.

(2) Nephrology Division – Chronic Ambulatory Peritoneal Dialysis Unit, Hospital Garcia de Orta

 

Recebido para publicação: 17/01/2006

Aceite para publicação: 17/05/2006