Bloody peritoneal dialysate (hemoperitoneum)
- Anthony Bleyer, MD, MS
Anthony Bleyer, MD, MS
- Professor of Internal Medicine/Nephrology
- Wake Forest University School of Medicine
- John M Burkart, MD
John M Burkart, MD
- Section Editor — Dialysis
- Professor of Medicine/Nephrology
- Wake Forest University Medical Center
Bloody peritoneal dialysate (hemoperitoneum) in the peritoneal dialysis patient is an uncommon occurrence. The etiology, diagnosis, and treatment of this problem will be reviewed here. Other abdominal disorders in dialysis patients, including abnormalities requiring immediate surgical therapy, are discussed separately. (See "Unique aspects of gastrointestinal disease in dialysis patients".)
ETIOLOGY AND EPIDEMIOLOGY
The incidence of hemoperitoneum varies from 6 percent overall to as high as 57 percent in premenopausal women [1,2]. Bloody peritoneal dialysate may be related to the peritoneal dialysis catheter, the peritoneal dialysis procedure, the underlying renal disease (such as polycystic renal disease or acquired cystic changes), or may be due to factors unrelated to renal disease. Performance of peritoneal dialysis exchanges allows early detection of intra-abdominal bleeding, including benign cases in patients not on peritoneal dialysis, in whom this finding would be otherwise clinically silent.
Causes of hemoperitoneum were reviewed in a single-center series of 424 patients; 26 patients (6 percent) developed one or more episodes of hemoperitoneum . Based upon severity and cause of bleeding, patients could be divided into different groups:
●In the largest group (n = 21) of cases, bleeding was mild, asymptomatic, and resulted in pinkish or red discoloration of the fluid. These patients were treated conservatively and did not receive extensive evaluation. Menstrual bleeding was believed responsible in seven cases, while a bleeding diathesis (use of warfarin or thrombocytopenia) was responsible in four patients.
●Peritoneal bleeding after transplant nephrectomy, increased physical activity, catheter repositioning, and femoral hematoma were responsible for single cases.
- Greenberg A, Bernardini J, Piraino BM, et al. Hemoperitoneum complicating chronic peritoneal dialysis: single-center experience and literature review. Am J Kidney Dis 1992; 19:252.
- Harnett JD, Gill D, Corbett L, et al. Recurrent hemoperitoneum in women receiving continuous ambulatory peritoneal dialysis. Ann Intern Med 1987; 107:341.
- Tse KC, Yip PS, Lam MF, et al. Recurrent hemoperitoneum complicating continuous ambulatory peritoneal dialysis. Perit Dial Int 2002; 22:488.
- Dimitriadis CA, Bargman JM. Gynecologic issues in peritoneal dialysis. Adv Perit Dial 2011; 27:101.
- Goodkin DA, Benning MG. An outpatient maneuver to treat bloody effluent during continuous ambulatory peritoneal dialysis (CAPD). Perit Dial Int 1990; 10:227.
- Miller R, Denman R, Saltissi D, et al. Erosion of a mesenteric vessel by a Tenckhoff catheter. Perit Dial Int 1996; 16:528.
- Van der Niepen P, Sennesael JJ, Verbeelen DL. Massive hemoperitoneum due to spleen injury by a dislocated Tenckhoff catheter. Perit Dial Int 1994; 14:90.
- de los Santos CA, d'Avila DO, von Eye O, Mottin CM. Rupture of the spleen: a complication of continuous ambulatory peritoneal dialysis. Perit Dial Int 1986; 6:203.
- Borràs M, Valdivielso JM, Egido R, et al. Haemoperitoneum caused by bilateral renal cyst rupture in an ACKD peritoneal dialysis patient. Nephrol Dial Transplant 2006; 21:789.
- Rinaldi S, Sera F, Verrina E, et al. The Italian Registry of Pediatric Chronic Peritoneal Dialysis: a ten-year experience with chronic peritoneal dialysis catheters. Perit Dial Int 1998; 18:71.
- García Falcón T, Rodríguez-Carmona A, Pérez Fontán M, et al. Complications of permanent catheter implantation for peritoneal dialysis: incidence and risk factors. Adv Perit Dial 1994; 10:206.
- Yap DY, Yip TP, Lui SL, Lo WK. Ruptured abdominal aortic aneurysm as a cause of spontaneous hemoperitoneum in a patient on peritoneal dialysis. Perit Dial Int 2011; 31:600.
- Warady BA, Bohl V, Alon U, Hellerstein S. Symptomatic peritoneal calcification in a child: Treatment with tidal peritoneal dialysis. Perit Dial Int 1994; 14:4.
- Pollock CA. Bloody ascites in a patient after transfer from peritoneal dialysis to hemodialysis. Semin Dial 2003; 16:406.
- Syed A, Holley JL, Piraino B. Splenic infarct presenting as sterile peritonitis with peripheral embolic phenomena. Adv Perit Dial 1993; 9:202.
- Lew SQ. Hemoperitoneum: bloody peritoneal dialysate in ESRD patients receiving peritoneal dialysis. Perit Dial Int 2007; 27:226.
- Fine A, Novak C. Hemoperitoneum due to carcinomatosis in the liver of a CAPD patient. Perit Dial Int 1996; 16:181.
- Fernández Girón F, Hermosilla Sánchez F, Parallé Alcalde M, González Martínez J. Hemoperitoneum in peritoneal dialysis secondary to retroperitoneal hematoma. Perit Dial Int 1996; 16:644.
- Campisi S, Cavatorta F, De Lucia E. Iliopsoas spontaneous hematoma: an unusual cause of hemoperitoneum in CAPD patients. Perit Dial Int 1992; 12:78.
- Lew SQ. Persistent hemoperitoneum in a pregnant patient receiving peritoneal dialysis. Perit Dial Int 2006; 26:108.
- Balafa O, Koundouris S, Mitsis M, Siamopoulos KC. An unusual case of hemoperitoneum: spontaneous rectus sheath hematoma. Perit Dial Int 2014; 34:134.
- Balsera C, Guest S. Hemoperitoneum in a peritoneal dialysis patient from a retroperitoneal source. Adv Perit Dial 2013; 29:69.
- Vas SI. Peritonitis. In: Peritoneal Dialysis, 3rd ed., Nolph KD (Ed), Kluwer Academic Publishers, Boston 1989. p.261.
- Walshe JJ, Lee JB, Gerbasi JR. Continuous ambulatory peritoneal dialysis complicated by massive hemoperitoneum after colonoscopy. Gastrointest Endosc 1987; 33:468.