Anchored but not safe: Rare but serious mechanical complications from peritoneal dialysis catheter suture fixation

Abstract Background Peritoneal dialysis (PD) catheter fixation techniques are frequently employed to minimize migration and optimize dialysate flow. While mechanical complications of PD catheters are well recognized, adverse events directly attributable to anchoring sutures are rarely described. We report two patients with end‐stage renal failure (ESRF) who developed clinically significant complications associated with prior catheter anchoring, illustrating both acute and chronic manifestations. Case Presentation The first case involved a 45‐year‐old female with diabetic nephropathy on PD who presented with acute abdominal pain and features of small bowel obstruction. Imaging demonstrated a transition point, and emergency laparotomy revealed internal herniation of small bowel through a loop formed by the PD catheter between an anchoring suture and its peritoneal insertion. Bowel ischemia necessitated segmental resection and primary anastomosis, followed by conversion to hemodialysis. The second case involved a 58‐year‐old male nursing‐home resident with ESRF on PD who developed recurrent catheter dysfunction. He had two prior adjustments and fixation of the current PD catheter over three years. His catheter was dysfunctional and mispositioned in the right hypochondrium on X‐ray. Laparoscopic evaluation demonstrated that the PD catheter had fractured into two. The fragments were removed, and a new catheter was inserted without suture fixation. Conclusion These cases highlight rare but clinically important complications related to fixed intra‐peritoneal points created by anchoring sutures. Such fixation may predispose to internal herniation, mechanical obstruction, or chronic catheter stress leading to spontaneous fracture. Increased awareness may inform surgical decision‐making regarding suture fixation of PD catheters.