Recurrent Transvaginal Leak of Dialysate as a Complication of Peritoneal Dialysis Catheter Tip Capture by Fallopian Tube after Tubal Occlusion

Abstract

Introduction: Peritoneal dialysis (PD) catheter malfunction may result from obstruction by various intra-peritoneal structures. Such obstruction may rarely be caused by fallopian tubes, in which case it may present as out flow failure and/or per vaginum (PV) leak of dialysate.
Case report: A 46 years old female developed early out-flow obstruction while maintaining adequate dialysate inflow soon after PD catheter insertion. The patient also had PV leak of the dialysate that was misinterpreted by the patient as urine incontinence. Fluoroscopic catheterogram confirmed catheter patency and outlined the right fallopian tube. Magnetic Resonance Imaging (MRI) revealed the presence of fluid in vagina with no obvious peritoneo-vaginal fistulous track. Laparoscopy was performed, at which time examination under anesthesia excluded the presence of peritoneo-vaginal fistula. During laparoscopy, the catheter tip was found to be captured by the fimbriae of the right fallopian tube. The catheter tip was released and right tubal occlusion was performed, after which adequate flow was restored. Three month later, the catheter was replaced because of fungal peritonitis. Vaginal leak recurred six weeks after insertion of the new catheter through the same occluded tube. Mini laparotomy and tubal ligation with catheter removal were done and the patient was maintained on hemodialysis until she received a kidney transplant four months later.
Conclusion: Vaginal leak of dialysate can occur as an early complication of PD secondary to fallopian tube capture of PD catheter tip. It is important to distinguish between tubal capture of the catheter tip which can be treated laparoscopically and peritoneo-vaginal fistula which often requires laparotomy for fistulous tract debridement and repair.

Key words: Peritoneal Dialysis, Dialysate, Transvaginal leak, Fallopian tube