A rare complication of Tenckhoff catheter insertion

A 57-year-old diabetic lady developed end-stage renal failure in 1998. A Tenckhoff catheter was inserted surgically in 1999. At the time of insertion, intra-abdominal adhesions were noted, which were thought to be related to her two previous caesarean sections. There were no gynaecological problems of note. Repeated episodes of peritonitis necessitated the removal of the Tenckhoff catheter in December 2001. She was then switched to haemodialysis. Lack of suitable peripheral blood vessels meant that the dialysis had to be provided through tunnelled dialysis lines. She was plagued by repeated episodes of line sepsis.

At the patient's request, a decision was made to try peritoneal dialysis once again and a Tenckhoff catheter was inserted laparoscopically in July 2002. Adhesions were once again noted, and some of these were lysed at the time of catheter insertion. At the first exchange 2 weeks later, she reported large volumes of the dialysate leaking per vaginam. A tenckhoffogram was done which revealed that the catheter tip was lodged in the left fallopian tube (Figure 1). The catheter was surgically repositioned.

Fig. 1.

Tenckhoffogram showing contrast in the catheter tube, left fallopian tube, uterus and vagina.

Injuries to various visceral organs including colon and urinary bladder during Tenckhoff catheter insertion have been reported. However, to our knowledge, this is the first case of fallopian tube cannulation due to Tenckhoff placement. Catheter obstruction caused by fallopian tube wrapping has been reported previously [1]. More recently, an unusual case of CAPD-related peritonitis associated with fallopian tube capture of the catheter has been reported [2]. Adhesions associated with previous surgeries and episodes of peritonitis probably contributed to this complication.

Conflict of interest statement. None declared.