Splenic abscess diagnosed following relapsing sterile peritonitis in a peritoneal dialysis patient: A case report with literature review

Metastatic squamous cell carcinoma in the residual spleen diagnosed with emergency ultrasonography: A case report

Metastatic squamous cell carcinoma (SCC) in the spleen is a rare malignant tumor primarily originating from areas covered by squamous epithelium. The present study reports the case of a 58-year-old man who had undergone a radical gastrectomy for gastric SCC and a subtotal splenectomy for anemia previously, and who now presented with abdominal pain. On presentation to the Emergency Department of Shaoxing Second Hospital (Shaoxing, China), a bedside emergency ultrasound (US) examination was performed, which revealed a mass mimicking a splenic abscess in the residual spleen. After ineffective anti-inflammatory treatment, a bedside US-guided biopsy was performed for subsequent treatment and confirmed the diagnosis of metastatic SCC in the residual spleen. Point-of-care US is the first-line imaging choice for patients with abdominal pain, as it can identify several pathological conditions. The present case shows that point-of-care US combined with bedside US-guided biopsy can be used to clarify the diagnosis.

Empyema associated with peritoneal dialysis peritonitis

A 65-year-old woman on peritoneal dialysis (PD) was admitted due to abdominal pain with cloudy PD effluent. The white blood cell count in PD effluent was 5860/µL with 85% polymorphonuclear neutrophils. Therefore, she was clinically diagnosed with peritonitis. The cultures of PD effluent were negative. Initial abdominal computed tomography did not find suggest any intraabdominal pathology. The patient was treated with empirical intraperitoneal antibiotics. Because abdominal pain with cloudy PD effluent persisted, the PD catheter was removed eventually. The culture of the removed PD catheter grew Klebsiella pneumoniae. However, intermittent fever was noted over the following days and empyema developed approximately 2 weeks after PD catheter removal. The culture of pleural fluid also grew K. pneumoniae. Another computed tomography revealed multiple intraabdominal abscesses that was assumed to come from a complication of PD-associated peritonitis. We postulate that the empyema might be caused by transdiaphragmatic extension of the intraabdominal abscesses into the pleural space.

Complications of Peritoneal Dialysis Part II: Nonmechanical Complications

Peritoneal dialysis (PD) is a form of KRT that offers flexibility and autonomy to patients with ESKD. It is associated with lower costs compared with hemodialysis in many countries. Unlike mechanical complications that typical arise early in the course of treatment, noninfectious, nonmechanical complications often present late in patients who are established on PD. In this review, we first discuss abnormal-appearing drained dialysate, including hemoperitoneum, chyloperitoneum, and noninfectious cloudy dialysate. The underlying cause is frequently unrelated to PD. We then discuss encapsulating peritoneal sclerosis, a rare complication of PD. Finally, we review metabolic changes associated with PD and methods to mitigate its effects.