Peritonitis following subcutaneous embedding of peritoneal dialysis catheters at PD discontinuation: two cases within a six-patient institutional series and a literature review

Abstract Background Subcutaneous embedding of a peritoneal dialysis (PD) catheter at the time of PD discontinuation has been proposed as a strategy to avoid invasive catheter removal while preserving the option of resuming PD in the future. However, the risk of peritonitis after catheter embedding remains poorly understood. We describe all six patients treated at our institution, focusing on the two who developed peritonitis. Case presentation Since 2020, six patients (four men; age range, 32–88 years) underwent secondary catheter embedding at PD discontinuation. PD duration ranged from 3 to 96 months, and five patients had prior PD-related peritonitis. At embedding, three had hypoalbuminemia and three had mildly elevated serum C-reactive protein levels. Embedding was selected to preserve a possible future PD option or reduce procedural burden because of frailty, comorbidity, or refusal of further surgery. During 14–63 months of follow-up, two patients developed three episodes of presumed endogenous peritonitis, whereas four had no documented peritonitis; no catheter was re-exteriorized. Both affected patients had discontinued PD because of ultrafiltration failure after long-term PD and had persistent ascites. Case 1 developed culture-negative, neutrophil-predominant peritonitis after antimicrobial exposure. Case 2 developed Campylobacter enteritis- associated peritonitis and later culture-positive peritonitis with Streptococcus mitis despite a low ascitic cell count. Antibiotics improved the acute inflammatory findings in both patients; persistent ascites and gastrointestinal symptoms prompted corticosteroid treatment for suspected evolving encapsulating peritoneal sclerosis (EPS). Conclusions This small, heterogeneous series cannot estimate peritonitis incidence or establish risk factors. Nevertheless, the occurrence of presumed endogenous peritonitis in two patients with persistent ascites after PD discontinuation suggests that careful patient selection and monitoring may be warranted.