Pneumoperitoneum in peritoneal dialysis patients

The prevalence and clinical significance of pneumoperitoneum in peritoneal dialysis (PD) patients is not fully defined in current literature and some reports suggest that unlike in non-PD patients, it is rarely caused by gast rointestinal perforation. We reviewed 403 chest X-ray films of the 118 PD p atients following our PD program in 1995-96, in order to define the prevale nce of pneumoperitoneum. We found pneumoperitoneum in 3.7% of the X-rays (1 5/403) from five patients (4.2%). Its causes might have been: faulty bag ex change technique in two cases and extension tube exchange in three. One pat ient suffered from a simultaneous episode of peritonitis. Our data and the literature review suggest that 0-11% of pneumoperitoneum episodes in PD pat ients are due to gastrointestinal perforation; the main causes generally ar e abdominal operations and catheter manipulation. The amount of air is not useful in assessing the cause of pneumoperitoneum, which takes some weeks t o disappear. Computed tomography is more sensitive than standard X-ray in d iagnosis.