Editor:
A 68-year-old man presented to our peritoneal dialysis (PD) unit with a foreign object protruding from his anus. One year before, a PD catheter had been laparoscopically inserted for post-renal end-stage kidney disease. The surgery and postoperative course were uneventful, but dialysis was not started because renal function improved after desobstruction measures.
The patient denied abdominal complaints, and a physical examination revealed no abnormalities except for the PD catheter protruding 2 cm from the anal sphincter (Figure 1). An abdominal radiograph showed the PD catheter elongated downward in the pelvis toward the anal sphincter (Figure 2). Under prophylactic antibiotic coverage, surgical removal of the catheter was performed by pulling, without opening the abdominal cavity. After careful monitoring for 1 week, the patient was discharged without complications.
Figure 1.
— A peritoneal dialysis catheter protrudes from the anal sphincter.
Figure 2.
— Radiographic view of the peritoneal dialysis catheter elongated downward in the pelvis.
Dislocation of the PD catheter is a well-known complication (1,2). Some centers perform prophylactic peritoneal fixation of the catheter (3). However, a PD catheter perforating the bowel and exiting from the anus has, to our knowledge, never before been reported. The asymptomatic spontaneous migration through the intestinal wall, the final anal presentation of the migration 1 year after catheter insertion, and the uneventful removal by pulling the catheter without opening the abdomen, are miraculous and never before seen. We are uncertain how the catheter perforated the bowel, but we speculate that the intra-abdominal fistula spontaneously closed after catheter removal.
DISCLOSURES
The authors have no financial conflicts of interest to declare.
References
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