ACUTE ABDOMINAL EMERGENCIES IN PATIENTS ON LONG-TERM AMBULATORY PERITONEAL-DIALYSIS

Objective: To review intercurrent abdominal emergencies in patients re ceiving long-term peritoneal dialysis on an ambulatory basis. Design: A chart review. Setting. Tertiary care referral centre. Patients: Seve n patients receiving long-term peritoneal dialysis, who suffered an ac ute abdominal emergency during a 7-year study period. Interventions: L aparotomy with appropriate management depending on the findings. Antib iotic therapy and dialysate culture. Results: In all patients the acut e abdominal process involved the colon: five patients had perforated d iverticulitis and two had ischemic colitis. The death rate overall was 57%. Peritonitis in these patients was difficult to differentiate fro m the peritonitis that occurs commonly in patients on long-term perito neal dialysis. As a result there was a delay in the initiation of ther apy ranging from 2 to 27 days. Conclusions: Coincidental abdominal eme rgency should be considered when patients receiving long-term peritone al dialysis on an ambulatory basis present with peritonitis that does not respond to established antibiotic protocols and when culture resul ts show evidence of multiple enteric organisms.