Challenges Faced in a CAPD Patient with Hemoperitoneum

A 54-year-old, nondiabetic male who had an ABOi spousal kidney transplant in May 2023 underwent graft nephrectomy elsewhere due to dysfunction. He was initially on hemodialysis (HD) from July 2023 and was switched over to continuous ambulatory peritoneal dialysis (CAPD) in January 2024 due to poor hemodynamic status. He had a Swan neck Tenckhoff catheter (Fig. 1A). He noticed intermittent reddish effluent (Fig. 1B) since March 15, 2024. He denied trauma to the abdomen and was not on anticoagulant or antiplatelet drugs. His complete blood count (CBC) and electrolytes were: Hemoglobin (Hb)-7.8 g/dL, white blood cell (WBC) count-10 × 10³ µL, platelet count-186 × 10³ µL, creatinine-10.01 mg/dL, sodium-139 mmol/L, potassium-4.08 mmol/L, bicarbonate-23.7 mmol/L with normal coagulation profile [prothrombin time (PT)-17 seconds, international normalized ratio (INR)-1.51 ratio] and normal liver function tests. Hepatitis B surface antigen (HBsAg) and anti-HCV Ab were negative.