Bacterial Peritonitis Following Esophagogastroduodenoscopy in a Patient on Peritoneal Dialysis.
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Date
2013-07
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Abstract
Aims: To recognize the importance of considering perforation of viscus in the
differential of peritonitis after upper gastrointestinal endoscopy in peritoneal dialysis
patients and to address the potential benefit of antibiotic prophylaxis in PD patients
undergoing upper GI procedures.
Presentation of Case: We report the case of a 54-year-old African American female
with end-stage renal disease on peritoneal dialysis presenting with generalized
abdominal pain, along with nausea and vomiting. Peritoneal fluid revealed a WBC count
of 1,499/mm3. Two days earlier, she had undergone an esophagogastroduodenoscopy
with biopsy. Broad spectrum antibiotics were started to treat possible peritonitis. Surgical exploration revealed no perforation but murky peritoneal fluid was noted and
gram stain showed mixed flora (both gram negative and gram positive rods); however,
blood and peritoneal fluid culture grew only Streptococcus pneumoniae.
Discussion and Conclusion: An occult perforation, which may not be obvious to the
naked eye or signs of contrast extravasation can occur after
esophagogastroduodenoscopy with manipulations and can lead to peritonitis, especially
in high-risk patients such as those with end-stage renal disease on peritoneal dialysis.
To our knowledge, this is the first reported case of mixed peritonitis attributable to
suspected micro-perforation after esophagogastroduodenoscopy. Whether preprocedure
antibiotics are warranted to decrease the occurrence of infectious
complications in PD patients undergoing upper gastrointestinal procedures remains
uncertain and not well studied. The prompt recognition of possible mixed bacterial
infection remains essential after these procedures.
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Keywords
Continuous ambulatory peritoneal dialysis, end-stage renal disease, gastrointestinal endoscopy, viscus perforation, peritonitis
Citation
Avusula Ramachandram, Shoemaker-Moyle Michael, Pathak Minesh B, Csongrádi Éva, Fülöp Tibor. Bacterial Peritonitis Following Esophagogastroduodenoscopy in a Patient on Peritoneal Dialysis. British Journal of Medicine and Medical Research. 2013 Jul-Sep; 3(3): 784-789.