Peritonitis due to a peritoneal vaginal fistula

Citation metadata

Date: March-April 2010
From: Nephrology Nursing Journal(Vol. 37, Issue 2)
Publisher: Jannetti Publications, Inc.
Document Type: Case study
Length: 1,467 words

Document controls

Main content

Article Preview :

Patient Profile

M.T. is a 50-year-old Chinese female with Stage 5 chronic kidney disease (CKD) secondary to glomerulonephritis treated with continuous cycling peritoneal dialysis (CCPD). Her pertinent medical history includes hypertension, renal anemia, hyperlipidemia, and known Hepatitis B surface antigen carrier. She is married, does not smoke, exercises daily, and previously worked full time in a local school district's accounting department. M.T. always follows her treatment plan, with optimal calcium and phosphorous control, and is adequately dialyzed. She has a good appetite but still requires a protein supplement to maintain an adequate albumin level. M.T. has been on CCPD for the past nine years, and during this time, she experienced only one case of peritonitis in July 2005 due to Streptococcus agalactiae group B. The infection responded to IV vancomycin and intrapetitoneal (IP) cefazolin, and was resolved. In 2004, M.T. complained of pain in her right side, and diagnostic studies revealed a mass in the tight kidney and an ovarian mass. A hysterectomy with bilateral salpingo-oophorectomy, creation of a vaginal cuff, and total nephroureterectomy was performed. No evidence of malignancy was found.

Case Presentation

In April, 2006, M.T. developed the first of three episodes of peritonitis within a three-month period of time.

April 17, 2006

M.T. presented with peritonitis due to enteroccocus faecalis.

* Treated with a two-week course of IP vancomycin and gentamycin.

* Negative peritoneal dialysis (PD) effluent culture on May 9, 2006.

May 20, 2006

Second episode of peritonitis developed.

* Treated empirically with IP vancomycin and gentamycin.

* Culture grew lactobacillus, a vaginal organism.

* Treatment changed to oral azithromycin 500 mg QD for 10 days.

* Follow-up culture on June 10, 2006, was negative.

June 15, 2006

Third episode of peritonitis developed due to enterococcus faecalis.

* Treated with IP vancomycin and gentamycin.

* M.T. was advised to have further investigation and possible PD catheter removal, but she refused.

June 24, 2006

A home visit was done to assess the patient's technique as well as dialysis set up, and no significant break in technique was noted.

July 2, 2006

M.T. reported urinary incontinence despite having been anuric for the last seven years.

* Analysis of "urine" revealed a very high glucose level with a suspicion that the patient was leaking...

Source Citation

Source Citation   

Gale Document Number: GALE|A225579729