{"title":"Sudden increase in \"urine\" output in a peritoneal dialysis patient.","authors":"T Cornelis, J M Bargman","doi":"10.3747/pdi.2009.00259","DOIUrl":null,"url":null,"abstract":"laparotomy is mandatory. However, when the patient’s vital signs are stable, the usual measure of severity of bleeding is to check the hematocrit of the effluent. If the drop in hematocrit is up to 2%, conservative treatment is sufficient (6) but heparinization of the PD fluid is necessary to prevent clotting within the catheter. Inferior epigastric artery injury has been reported during percutaneous PD catheter insertion using a paramedian approach (7). The midline approach used in our patients avoids this possible complication. There have been no previously reported cases of jejunal mesenteric arterial laceration following the procedure. While this is rare, we wish to highlight the potential for injury to the intra-abdominal vasculature during the procedure. The omentum lies just over the bowel and the omental vessels are also potentially a source of bleeding. To minimize this, care must be taken to fill the peritoneal cavity with fluid so that the bowel floats freely and the likelihood of vascular injury is reduced. The cannula used to fill the peritoneal cavity must be gently maneuvered to go just below the level of the linea alba. Also, care must be taken that the trocar and cannula penetrate the linea alba but stop short of the viscera. When the catheter is introduced, the stiffening stylet must be maintained at a position just sufficient to permit the catheter to enter the peritoneal cavity. If there is any bloody discoloration of the effluent with hemodynamic compromise, along with volume resuscitation and blood transfusion, an immediate explorative laparotomy is mandatory. Blind percutaneous PD catheter introduction is becoming increasingly popular and can be done easily. While the procedure is usually safe, injury to intraabdominal vasculature is possible. If serious vascular injury is suspected, an immediate explorative laparotomy to identify and eliminate the source of bleeding must be undertaken.","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"574-6"},"PeriodicalIF":0.0000,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2009.00259","citationCount":"5","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3747/pdi.2009.00259","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 5
Abstract
laparotomy is mandatory. However, when the patient’s vital signs are stable, the usual measure of severity of bleeding is to check the hematocrit of the effluent. If the drop in hematocrit is up to 2%, conservative treatment is sufficient (6) but heparinization of the PD fluid is necessary to prevent clotting within the catheter. Inferior epigastric artery injury has been reported during percutaneous PD catheter insertion using a paramedian approach (7). The midline approach used in our patients avoids this possible complication. There have been no previously reported cases of jejunal mesenteric arterial laceration following the procedure. While this is rare, we wish to highlight the potential for injury to the intra-abdominal vasculature during the procedure. The omentum lies just over the bowel and the omental vessels are also potentially a source of bleeding. To minimize this, care must be taken to fill the peritoneal cavity with fluid so that the bowel floats freely and the likelihood of vascular injury is reduced. The cannula used to fill the peritoneal cavity must be gently maneuvered to go just below the level of the linea alba. Also, care must be taken that the trocar and cannula penetrate the linea alba but stop short of the viscera. When the catheter is introduced, the stiffening stylet must be maintained at a position just sufficient to permit the catheter to enter the peritoneal cavity. If there is any bloody discoloration of the effluent with hemodynamic compromise, along with volume resuscitation and blood transfusion, an immediate explorative laparotomy is mandatory. Blind percutaneous PD catheter introduction is becoming increasingly popular and can be done easily. While the procedure is usually safe, injury to intraabdominal vasculature is possible. If serious vascular injury is suspected, an immediate explorative laparotomy to identify and eliminate the source of bleeding must be undertaken.