Region - Educational Research and Reviews

Objective: To investigate the clinical features of peritoneal dialysis-associated peritonitis complicated with intestinal obstruction, and provide evidence for the prevention and treatment of peritonitis with intestinal obstruction. Methods: 11 patients with peritoneal dialysis-associated peritonitis complicated with intestinal obstruction were recruited from January 2017 to December 2022. Their clinical manifestations, laboratory tests, imaging manifestations, treatment plans and prognosis were analyzed. Results: Of the 11 patients, 5 were male and 6 were female; 8 had chronic glomerulonephritis (CGN) and 3 had diabetic nephropathy (DN) as the primary disease. All patients had anemia (8 cases<100g/L), elevated C-reactive protein, procalcitonin, and erythrocyte sedimentation rate, plasma albumin less than 35g/L, and potassium (9 cases hypokalemia, 2 cases hyperkalemia). The peritoneal dialysis fluid routine total leukocyte count was significantly elevated (367±157.00)×106 /L and the neutrophil percentage was (85.73±4.60)%; Positive cell culture of peritoneal permeate is 100%, with 4 cases of Escherichia coli, 1 case of Enterococcus faecalis, 1 case of Staphylococcus aureus, 1 case of Staphylococcus capitis, 1 case of Klebsiella pneumoniae, 1 case of Pseudomonas aeruginosa, and 2 cases of 2 were fungi. All patients were treated with abdominal plain film or abdominal CT examination, which indicated extensive pneumoperitoneum and fluid accumulation in the intestinal canal of the abdominal cavity. 4 patients had their symptoms relieved after treatment and continued maintenance peritoneal dialysis, with an improvement rate of 36.37%. 5 patients had their symptoms of peritonitis or intestinal obstruction persistently unrelieved despite active treatment, and the peritoneal dialysis catheter was removed and replaced with hemodialysis treatment, with an extraction rate of 45.46%. Two patients died, with a mortality rate of 18.18% and a total treatment failure rate of 63.64%. Conclusion: Enteric-derived bacteria are common causative agents of peritoneal dialysis-associated peritonitis, and patients need to be alert to the occurrence of intestinal obstruction once and in combination with hyperinflammatory state, anemia, hypoproteinemia and hypokalemia, which should be detected early and treated promptly.