B ZAHOROWSKA1, I DE GUZMAN1, B CLELAND1, A ARAVINDAN1, J WONG1
1Liverpool Hospital, Liverpool, New South Wales
Background: Peritoneal dialysis (PD) catheter insertion can be performed by percutaneous Seldinger technique with ultrasound guidance and image intensification to confirm intraperitoneal positioning. Disposable catheter insertion kits are used by our institution and have the advantage of simplicity and portability of pre-packaged sterile equipment. A significant disadvantage of certain pre-assembled kits is the inclusion of radiolucent components that are at risk of displacement and inadvertent retention in the peritoneal cavity or insertion wound.
Case Report: We report a unique case of a 60 year old female with recurrent PD peritonitis on a background of diabetic nephropathy and hypertension. Her PD catheter had been inserted using percutaneous Seldinger technique and the CovidienTM PD Catheter kit in 2013. Since PD commencement, the patient was treated for six episodes of peritonitis comprising of two staphylococcus haemolyticus, and four culture-negative episodes. In 2017 she presented with multiple organism peritonitis (K. Oxytoca, E.Faecalis and Streptococcus species) and was found to have an erythematous wound with purulent discharge superomedial to her peritoneal catheter exit site. An abdominal computer tomography scan was unremarkable whereas abdominal wall ultrasound identified a subcutaneous, 3.4cm plastic blind-ending foreign body immediately adjacent to the PD catheter. Surgical exploration of the wound retrieved a pus-filled plastic cap which was identified as a component of the CovidienTM blunt tunneling stylet.
Conclusions: This case demonstrates the risk of retained radiolucent components of PD catheter insertion equipment resulting in recurrent peritonitis. The foreign body was not identified until four years post insertion due to initial lack of superficial skin and exit site changes and was only found with dedicated ultrasound imaging. Our institution no longer uses the aforementioned tunneling stylet.