Retroperitoneal leakage causing ultrafiltration failure during continuous ambulatory peritoneal dialysis: a case report and literature review

Abstract Background Peritoneal dialysis (PD) is associated with various complications, and the leakage of dialysate can lead to the discontinuation of PD. Retroperitoneal leakage (RPL) can be diagnosed on the basis of dialysate leakage, and, because there are few reports of this complication, clinicians often have an incomplete understanding of its diagnosis, causes, and treatment options. Case presentation A 59-year-old man who underwent continuous ambulatory peritoneal dialysis (CAPD) 1 year prior to admission was referred to our department owing to right-sided abdominal swelling and persistent ultrafiltration failure (UFF). No abnormalities were observed at the catheter exit or tunnel site. Plain abdominal computed tomography (CT) revealed that the catheter was not malpositioned and that fluid had accumulated in the right retroperitoneal space, causing edema in the abdominal wall. If UFF persists, CAPD must be discontinued and patients must be hospitalized. Subsequently, computed tomographic peritoneography (CTP) following the instillation of 2 L of dialysate with contrast agent revealed clear progression of the contrast agent into the right retroperitoneal space, confirming RPL owing to retroperitoneal injury at the dorsal aspect of the ascending colon. Conclusions As a rare complication of PD, RPL causes few local symptoms and is therefore often unrecognized, resulting in UFF. Thus, CTP is useful for diagnosing RPL in the presence of dialysate leakage. However, if we were fully educated on RPL, we could have diagnosed it when plain CT scans were performed.