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NDT Advance Access originally published online on July 19, 2005
Nephrology Dialysis Transplantation 2005 20(10):2292; doi:10.1093/ndt/gfh999
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

Letter

True Aneurysm rupture of omental artery leading to hemoperitoneum and shock in a CAPD patient

Sir,

Haemoperitoneum is a rare complication in continuous ambulatory peritoneal dialysis (CAPD) patients. In most cases, haemoperitoneum subsides by itself or by flushing the peritoneal cavity several times with the peritoneal dialysis solution [1,2]. Haemoperitoneum by rupture of visceral aneurysms in CAPD patients is rare [3]. We report a case of true aneurysmal rupture of the omental artery in a patient undergoing CAPD.

A 71-year-old male on CAPD was transferred to our hospital, due to continuous bloody peritoneal effluents and decrease of consciousness. After he was transfused with 200 ml of packed red blood cells at a hospital nearby, the patient was immediately transferred to our hospital because of unstable vital signs and bloody peritoneal effluents. Bloody peritoneal fluid was persistently drained through the CAPD catheter at our hospital. He was in a confused mental state. His blood pressure was 80/60 mmHg, body temperature was 36.7°C, pulse rate was 126/min and respiratory rate was 20/min. Laboratory data showed a leukocytosis (white blood cells 16 300/mm3, segmented neutrophils 70%) and his haemoglobin level was 8.2 g/dl.

Free air was not detected on the simple erect chest film. Computed tomographic angiography revealed aneurysmal dilatation of the paracolic gut accompanied by haematoma (Figure 1). We preferred an exploratory laparotomy for the purpose of making a definite diagnosis and determining treatment. An aneurysm of 16 mm in diameter was detected at the margin of the greater omentum covered with blood clots. Omentectomy and aneurysmal resection were performed. The pathology showed a dilated true vessel lumen with all layers. The patient was discharged at 18 days after the operation and was judged to be without sequelae. He is doing well and continues on peritoneal dialysis.



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  		Fig. 1. The CT angiography showed an aneurysmal dilatation of the vessel (arrow). Haematoma is seen around the dilated vessel.

 
In this case, true aneurysmal rupture of the omental artery was the cause of a massive haemoperitoneum in our patient undergoing CAPD. Several cases of massive haemoperitoneum in CAPD patients have been reported [4–6]. However, to our knowledge, haemoperitoneum caused by rupture of the true omental artery in a CAPD patient has not been reported. Even though this case is extremely rare, we should always suspect this critical condition in a patient undergoing peritoneal dialysis if bloody peritoneal effluent is observed.

Conflict of interest statement. None declared.

Dong Jun Park1, Kook-Hwan Oh2, Sang Joon Kim3, Kwon Wook Joo4, Jin Suk Han4, Suhnggwon Kim4, Jung Sang Lee4 and Curie Ahn4

1 Department of Internal Medicine College of Medicine Gyeongsang National University2 Department of Internal Medicine Hallym University Medical School3 Department of Surgery Seoul National University4 Department of Internal Medicine Seoul National University Email: curie{at}snu.ac.kr

References

  1. Tse KC, Yip PS, Lam MF et al. Recurrent hemoperitoneum complicating peritoneal dialysis. Perit Dial Int 2002; 22: 488–491[Abstract/Free Full Text]
  2. Greenberg A, Bernardini J, Piraino BM, Johnston JR, Perlmutter JA. Hemoperitoneum complicating chronic peritoneal dialysis. Single-center experience and literature review. Am J Kidney Dis 1992; 19: 252–256[Medline]
  3. Wagner WH, Allins AD, Treiman RL et al. Ruptured visceral artery aneurysms. Ann Vasc Surg 1997; 11: 342–347[CrossRef][Web of Science][Medline]
  4. Macia M, Pulido-Duque JM, Hortal L et al. Percutaneous embolization of splenic artery pseudoaneurysm as a treatment of hemoperitoneum in peritoneal dialysis patient. Perit Dial Int 1993; 13: 157–159[Medline]
  5. Dozio B, Scanziani R, Rovere G, Sangalli L, Sacerdoti S, Surian M. Hemoperitoneum in a peritoneal dialysis patient caused by a hepatocellular carcinoma, treatment with percutaneous embolization. Am J Kidney Dis 2001; 38: E11[Medline]
  6. Kanagasundaram NS, Macdougall IC, Turney JH. Massive haemoperitoneum due to rupture of splenic infarct during CAPD. Nephrol Dial Transplant 1998; 13: 2380–2381[Abstract/Free Full Text]

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This Article
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gfh999v1
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