Tubal fimbria encapsulation of peritoneal dialysis catheter diagnosed by laparoscopy: a case report and literature review

Abstract

A well-functioning peritoneal dialysis (PD) catheter is a crucial factor for the successful PD therapy. Catheter dysfunction is the most common complication following PD catheter insertion. PD catheter obstruction caused by the fallopian tube fimbriae is an unusual complication that is challenging to diagnose clinically. Laparoscopic surgery is necessary to restore catheter function. We present a 39-year-old woman with chronic kidney disease who had received continuous ambulatory peritoneal dialysis (CAPD)for three months. The patient presented with a decreased outflow rate of dialysis fluid, without accompanying symptoms such as abdominal pain or cloudy dialysate. An abdominal X-ray showed that the catheter tip had migrated out of the pelvic cavity. In the following 20 days, attempts to restore the catheter patency using flushing, bowel management, increased physical activity, and tube sealing with heparin were all unsuccessful. Diagnostic laparoscopy revealed that the right fallopian tube fimbriae wrapped around the PD catheter. The catheter was released and fixed to the anterior abdominal wall. Postoperative catheter function returned to normal, and no recurrence were observed during the 16-month follow-up. In female PD patients, catheter dysfunction should arouse clinical suspicion of fallopian tube fimbriae wrapping. Preoperative differentiation between fallopian tube wrapping and omental wrapping can be challenging. Laparoscopic surgery is beneficial for diagnosing and resolving catheter dysfunction. Nevertheless, interventions including PD catheter fixation as well as tubal fixation or resection, should be individualized based on patients’ specific clinical presentations. Currently, no unified standardized guidelines are available for the clinical management of this condition.