An Unusual Complication in a Patient on CAPD – Retroperitoneal Hemorrhage: A Case Report

Abstract

Background: Hemoperitoneum is an infrequent but recognized complication of continuous ambulatory peritoneal dialysis (CAPD), most commonly attributable to abdominal trauma, gynecological causes (follicular cyst rupture, menstrual reflux, ovulation, endometriosis), or intraperitoneal sources such as hepatic or splenic cyst rupture, catheter-related trauma, and vascular anomalies. Hemoperitoneum originating from a retroperitoneal source, particularly cyst rupture in autosomal dominant polycystic kidney disease (ADPKD), is exceedingly rare and has been reported only twice previously in the literature. Case Presentation: We describe a 45-year-old postmenopausal woman with a 20-year history of ADPKD and ESKD on CAPD, who presented with hemorrhagic peritoneal dialysate outflow followed by complete outflow obstruction, anasarca, and altered sensorium. Imaging demonstrated a large intraperitoneal collection with air foci alongside a separate lesser-sac collection, in the absence of any demonstrable retroperitoneal-to-peritoneal communication or active contrast extravasation. No alternative source of hemorrhage was identified after multidisciplinary evaluation. The patient was managed with temporary discontinuation of CAPD, hemodialysis via a non-tunneled internal jugular catheter, blood transfusion, and intraperitoneal antibiotic therapy, with gradual clinical improvement. Conclusion: Retroperitoneal hemorrhage should be considered in the differential diagnosis of hemoperitoneum in patients with ADPKD on peritoneal dialysis. Prompt recognition of pain and hemorrhagic dialysate in this population is essential to enable timely intervention and salvage of the peritoneal dialysis modality.