Delayed diagnosis of intestinal perforation related to peritoneal dialysis. A case report

Background: The placement of peritoneal dialysis catheters can be performed using surgical techniques (such as open surgery or laparoscopy) or percutaneous methods (such as the Seldinger technique). Each method has its advantages and disadvantages, and none has been proven superior to the others. Therefore, the choice of method should be based on the patient's condition, available resources, and the professional's experience. Open surgery is associated with a high catheter malfunction rate, while percutaneous placement may cause perforations of internal organs. Although intestinal perforation is a rare complication, it occurs in approximately 1% of patients, with a 0.4% rate reported between 1992 and 2005 in the U.S. This complication may occur without obvious symptoms, complicating diagnosis. In the analyzed case, it is suspected that the perforation occurred due to the "blind" insertion of the guidewire. Clinical manifestations can range from watery diarrhea to peritonitis, and some patients may not present symptoms. Intra-abdominal adhesions are a risk factor that can be addressed during laparoscopic catheter placement, which, according to a meta-analysis, provides better outcomes by allowing additional procedures that ensure catheter functionality. In this case, the patient showed mild symptoms over three weeks and did not have a significant inflammatory response, likely due to immunosuppressive treatment for dermatomyositis. Keywords: Peritoneal dialysis, Tenckhoff catheter, intestinal perforation, percutaneous insertion, laparoscopy, ileal perforation.