Nonocclusive mesenteric infarction has recently been diagnosed with in
creasing frequency in dialysis patients. Although most reports have co
ncerned patients on hemodialysis, the condition has also been reported
to occur in patients on continuous ambulatory peritoneal dialysis. Th
is report describes such a case developing in a woman whose end-stage
renal failure was due to adult polycystic kidney disease. Associated p
redisposing factors were the presence of orthostatic hypoxemia, postur
al hypotension and extensive atheromatous changes of the abdominal aor
ta. In keeping with the known difficulty of establishing the diagnosis
of mesenteric ischemia, the diagnosis in our patient was also delayed
. She was initially thought to suffer from an episode of peritonitis a
nd/or colonic perforation secondary to the performance of a cleansing
enema. Only upon showing pneumatosis coli of the right colon on abdomi
nal computerized tomography was the correct diagnosis made. Laparotomy
revealed extensive necrosis of the ascending and transverse colon. A
total colectomy and ileorectal anastomosis were performed. The patient
died on the 17th day following surgery. This case serves to illustrat
e that mesenteric infarction should be considered in predisposed patie
nts on continuous ambulatory peritoneal dialysis. The presence of peri
tonitis may mask the underlying pathology and waylay the unwary physic
ian.