ACUTE ABDOMEN IN PATIENTS UNDERGOING CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD)-REPORT OF TWO CASES-

Two cases of acute abdomen in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) are reported. Case 1: A 48-year-old man complained of an abdominal pain followed by a cloudy dialysate return. With a clinical and ultrasonographic diagnosis of appendiceal abscess, an appendectomy and drainage of the abscess were performed. Case 2: A 63-year-old man presented with an abdominal pain and a melena. The dialysate return was cloudy, in which S. epidermidis was isolated. Colonoscopy showed longitudinal ulcers in the splenic flexure and a diagnosis of ischemic colitis was made. Neither clinical nor radiographic finding was diagnostic of the perforation, and the patient was treated conservatively. He died of a sudden septic shock on the 11th hospital day. The autopsy revealed perforated ischemic coloitis. Diagnosis of acute peritonitis due to perforation is difficult in patients on CAPD due to the daily peritoneal lavage. Our experience suggests that early surgical treatment is necessary when perforation is possibly suspicious.