Successful Simultaneous Peritoneal Dialysis Catheter Removal and Reinsertion During Surgical Repair of Acute Small Bowel Perforation: A Case Report.

Abstract

Bowel perforation is a rare but serious complication of Tenckhoff catheter placement for peritoneal dialysis (PD), particularly when blind insertion techniques such as the Seldinger method are used. Standard management typically involves catheter removal, surgical repair of the bowel, and delayed reinsertion of a new catheter following completion of systemic antibiotic therapy. Although this approach minimizes the risk of infection, it necessitates a second surgical procedure and can significantly delay the initiation of PD. We report the case of a 60-year-old woman with end-stage kidney disease secondary to diabetic nephropathy who developed small bowel perforation during Tenckhoff catheter insertion via the Seldinger technique. To avoid a second operation, and in accordance with the patient's preference, simultaneous catheter removal and contralateral reinsertion were performed during surgical repair of the perforation. The peritoneal cavity was irrigated with 2.5 L of normal saline, a drain was placed, and the patient received a 14-day course of intravenous meropenem with peritoneal rest. The drain was removed on postoperative Day 5, and automated PD was successfully resumed two weeks later without any evidence of peritonitis. This case suggests that simultaneous catheter removal and reinsertion during bowel repair may be technically feasible under specific, favorable intraoperative conditions, potentially avoiding an additional procedure and facilitating earlier return to PD. However, this approach is not supported by current guidelines, which recommend delayed catheter reinsertion to allow adequate peritoneal healing, and should not be considered standard practice.