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Case Reports
. 2020 Feb 20:2020:1309418.
doi: 10.1155/2020/1309418. eCollection 2020.

A Rare Cause of Persistent Blood Loss after Continuous Ambulatory Peritoneal Dialysis Catheter Placement

T Natroshvili  1 , T Elling  1   2 , S A Dam  1 , M Vd Berg  1 , R R H Nap  2 , R J Hissink  1
Affiliations
Case Reports

A Rare Cause of Persistent Blood Loss after Continuous Ambulatory Peritoneal Dialysis Catheter Placement

T Natroshvili et al. Case Rep Surg. .

Abstract

The laparoscopic placement of a continuous ambulatory peritoneal dialysis (CAPD) catheter is a widely used method in patients with end stage renal disease (ESRD). The potential complications of this procedure include perforation of intra-abdominal organs, surgical site infection, peritonitis, catheter migration, catheter blockage, port site herniation, and bleeding. In most cases, bleeding is considered to be an early-onset complication because it mostly occurs within the first seven days after surgery. We report a case of a 68-year-old female patient with a previous history of diabetes mellitus, myelodysplastic syndrome, extensive collateral varices, anaemia, and ESRD due to obstructive uropathy caused by retroperitoneal fibrosis, who presented with persistent blood loss after the laparoscopic placement of a CAPD catheter. Duplex ultrasonography showed that the CAPD catheter was transfixing a superficial epigastric varicose vein, a collateral vein, due to the occlusion of the left external iliac vein. Persistent blood loss after inserting a CAPD catheter without previous imaging of abdominal wall vessels is an indication for further diagnostics.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
(a) CAPD catheter passing through a large epigastric varicose vein, as visualized with duplex ultrasonography. Schematic presentation of the duplex ultrasonography. The left external iliac vein (VIE) seemed to be completely occluded. The common iliac vein (VIC) cannot be visualized properly. At the height of the mid common femoral vein (VFC), the duplex revealed the existence of various abdominal wall varices, with relatively high flow, which can be followed all the way to the sternum. The CAPD catheter had been located in one of these superficially located abdominal wall varices. VIE: external iliac vein; VIC: common iliac vein; VFC: common femoral vein; VFP: profunda femoris vein; VFS: superficial femoral vein. (b) Duplex ultrasonography showing the position of the CAPD catheter (arrow) in a variceous abdominal wall vein.
Figure 2
Figure 2
Reconstruction of the abdominal wall with a superficial collateral vein from a CT performed in 2013.
See this image and copyright information in PMC

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