Peritoneal Dialysis Catheter Migration into an Inguinal Hernia

Introduction: Peritoneal Dialysis (PD) is associated with improved patient quality of life compared to hemodialysis. There are important infectious and non-infectious complications of PD that must be recognized to facilitate successful therapy. We present a case of an End Stage Renal Disease (ESRD) patient on Continuous Cyclic Peritoneal Dialysis (CCPD) therapy who presented with catheter malfunction secondary to outflow obstruction. Case Description: 77-year-old male with a history of ESRD on CCPD and bilateral inguinal hernias presented to the ED with PD catheter drainage problems for 2 days. He underwent a physical exam, a pelvis x-ray (Fig.1) and a CT Abdomen and Pelvis showing a migration of the catheter from the posterior left hemipelvis through his right inguinal hernia into the scrotum (Fig 2). Surgery was consulted and the patient underwent laparoscopy repositioning of the PD catheter and laparoscopic bilateral inguinal hernia repair with mesh (extraperitoneal approach). PD was held after surgery and restarted 48 hrs later with low fill volumes. The patient has continued PD without additional complications to date. Discussion: It is important to recognize noninfectious complications of PD, including causes of poor catheter drainage. Inguinal hernias are common noninfectious complications in PD (reported in 4–14% of patients). There are several case reports on patients with decreased PD catheter drainage where the catheter was found to have migrated through the inguinal hernia sac. Surgery, ultimately, allowed these patients to continue with PD. Prompt identification and repair of inguinal hernias can facilitate continued PD and prevent catheter drainage issues. Careful physical examination and correction of inguinal hernias are important for PD patients.