지속성 외래 복막 투석환자에서 발생한 급성 담낭염을 동반한 담즙성 복막염 1예

Abstract

Peritonitis is the most common complication of CAPD (continuous ambulatory peritoneal dialysis). Major cause of peritonitis is bacterial infection by septic manipulation and catheter exit infection. In patients with CAPD, bile peritonitis by acute cholecystitis is rare. A 80-year-old female patient who had been treated with CAPD for 18 months visited our hospital for abdominal pain and change of dialysate color. These symptoms suggested peritonitis. Although we administered intraperitoneal antibiotics, abdominal pain did not subside. Therefore, we checked abdomen computerized tomography. CT findings showed gall bladder stone with distension, wall thickening and pericholecystic fluid collection. Acute cholecystitis with microperforation was suspected. She underwent percutaneous transhepatic gall bladder drainage and systemic antibiotics therapy. After conservative treatment, abdominal pain was subsided and peritoneal fluid came out clear. The patient was discharged and maintained on CAPD When CAPD patients visit hospital due to abdominal pain and dialysate color change (dark brown color or greenish color), physicians should consider bile peritonitis and early treatment.