PD leaks

what can you tell me about leaks with PD. I have a pt who has a leak into scrotum(med-large leak) We have tried smaller volumes(1000), with not much success. He is on cylcer. He desparately does not want Hemo.

Hi Peggy,

I’m NOT a PD professional, but I did a quick PubMed search, and found a 1995 article that addresses your question:

Mil Med. 1995 Nov;160(11):597-8.
Occult inguinal hernia, a cause of rapid onset of penile and scrotal edema in patients on chronic peritoneal dialysis. Deshmukh N, Kjellberg SI, Shaw PM.

From 1976 to 1993 we inserted 160 chronic peritoneal dialysis catheters for renal failure patients. Three of these patients developed sudden onset of penile and scrotal edema after the catheter had been in place for several months. The first patient was diagnosed by instilling technetium sulfur colloid in the peritoneal cavity, which showed the radioisotope flowing via the right inguinal canal. He was operated on and the processus vaginalis was tied off and the scrotal and penile edema resolved. Subsequently, two more patients were seen with similar problems and had their inguinal canals explored and the processus vaginalis in one and the hernia sac in the other were found and tied off, which resulted in resolution of the problem. This is an uncommon complication, reported to occur in 3 to 4% of patients.

This pt. needs to be assessed for a hernia and if he has one, have it repaired. He will need to hold PD temporarily 4-6 weeks and do hemo. This will give the surgical site enough time to heal. If you resume PD too soon, the leak may reoccur.

What about LVRO PD? Can that be done after hernia surgery to avoid the need for an HD catheter?

You can read a brief article on low volume recumbent only PD at www.homedialysis.org/v1/rotating/0505topicofthemonth.shtml. Here’s the abstract of a report on its use in a few post-hernia patients. You might want to email the author to see if they have had continued success with additional patients since this study was published in 2002.

EDTNA ERCA J. 2002 Oct-Dec;28(4):173-5
Continuing CAPD after herniotomy.
Tast C, Kuhlmann U, Stolzing H, Alscher D, Mettang T.

Robert-Bosch-Hospital, Department of Internal Medicine, Division of General Internal Medicine and Nephrology, Stuttgart, Germany. c.tast@t-online.de

There is still controversy as to whether PD-treatment can be safely continued after herniotomy (HT). Many nephrologists withhold PD-treatment for several weeks after HT in fear of dialysate leakage and/or hernia recurrence. We report on 12 patients (2 women, 10 men) in whom HT was performed either for umbilical (n = 6), inguinal (n = 6) or open processus vaginalis (n = 3). Surgery was performed according to the Lichtenstein method with insertion of a Marlex-mesh and ligation of the hernia sac. In all patients PD treatment was paused for the day of surgery and 1 to 3 days postoperatively, depending on RRF. Low volume (1.0 to 1.5 l) and high frequency exchanges (6 exchanges per day) were started for several days with a gradual reinstitution of the former PD-regimen within the next 2 to 4 weeks. All patients did well rapidly with no uraemia-or dialysis-related complications. No leakage and no hernia recurrence could be observed 3 months thereafter. None of the patients had to be haemodialysed intercurrently. In conclusion, continuing a modified regimen of PD-treatment after HT seems to be safe and comfortable for the patient.