Lower anterior abdominal wall pericatheter collection (CT peritoneography)
Presentation
Underlying end-stage renal failure on continuous ambulatory peritoneal dialysis. Noted a recurrent catheter exit site infection and a peritonitis. To rule out a peritoneal defect.
Patient Data
Tenckhoff catheter seen at the left anterior lower abdominal wall with its curved tip within the central pelvis. No kinking, fracture, or entrapment of the catheter observed. No pericatheter contrast leak.
Subcutaneous thick wall pericatheter collection with adjacent fat streakiness noted. No contrast leak or air pockets are seen.
No contrast leak along the anterior or posterior peritoneum.
Another subcutaneous track is noted at the right lower anterior abdomen, likely due to the previous Tenckhoff catheter insertion site.
Homogeneous distribution of contrast and dialysate mixture within the peritoneal cavity. No loculation or septation observed.
Umbilical hernia noted with bowel within. Contrast and dialysate mixture content are also present.
Focus of calcification in the segment V of liver.
The peritoneal spaces are shown below:
left anterior renal fascia (Gerota fascia)
left posterior renal fascia (Zuckerkandl fascia)
4 hours post contrast infusion
No contrast leak was seen at 4 hours post contrast infusion.
Case Discussion
Before the CT peritoneography, the dialysate within the peritoneal cavity is completely drained. Then 100 mL of low osmolar contrast medium mixed with 2 L of dialysate is infused into the peritoneal cavity. The patient then walks for 30 minutes to 1 hour before the CT scan. No oral or intravenous contrast is given. Images are acquired in supine and prone positions.
Another scan is done 4 hours later in the prone position to look for any delayed leak from the peritoneum.
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