A gripping case of peritoneal dialysis catheter malfunction

A 76-year-old woman with end-stage renal disease was started on peritoneal dialysis using a Swan neck–type catheter (Figure 1). After 1 week of successful peritoneal dialysis, major effluent problems arose. An abdominal X-ray showed the catheter tip being located correctly in the minor pelvis. Empiric attempts to restore catheter function with laxatives and intra-catheter instillation of urokinase failed to improve the effluent flows. A relook laparoscopy showed impingement of the catheter orifices by fimbriae of the right fallopian tube. The catheter was subsequently surgically unobstructed and fixed medially to the anterior abdominal wall, whereas the right ovarium was fixed laterally in the right iliac fossa. Two weeks later, peritoneal dialysis was resumed without any further catheter problems.