腹膜透析(peritoneal dialysis，PD)相关性腹膜炎通常由于接触污染或者出口处感染引起。也有少部分腹膜炎起因于肠道疾病，其中最常见的病因包括胃肠道穿孔、缺血性肠病和胆囊炎等。因梗阻性脓肾引起的腹膜炎极为罕见。该文报道了1例72岁男性腹膜透析患者因梗阻性左肾积脓引起的继发性腹膜炎，行左肾盂造瘘引流术和左肾切除术，最后未拔除腹膜透析管而继续腹膜透析治疗。随访8个月未再次发生腹膜炎。本研究报道了国内首例因梗阻性脓肾引起的持续不卧床腹膜透析合并继发性腹膜炎的病例，以提醒临床医生腹膜透析继发性腹膜炎可能的病因，为临床治疗决策提供依据。
Peritoneal dialysis (PD)-associated peritonitis is usually caused by contamination of the PD system or infection of exit site. Peritonitis may sometimes be present with gastrointestinal diseases, such as intestinal perforation, ischemic bowel disease or cholecystitis. PD-associated peritonitis due to obstructive pyonephrosis is rarely seen. Here we report the first case of PD-associated peritonitis due to obstructive pyonephrosis in a 72-year-old PD patient in China. He was then subjected to a left-sided percutaneous nephrostomy and nephrectomy without removal of the peritoneal dialysis catheter. No peritonitis relapsed in the next 8 months after the operation. From this case we can draw the experience that PD-associated peritonitis may derive from a focal infection, which is of diagnostic and therapeutic importance.
[1] Masaki C, Matsushita K, Inoue T, et al. Splenic abscess diagnosed following relapsing sterile peritonitis in a peritoneal dialysis patient: A case report with literature review[J].Semin Dial,2021 ,34(3):245-251. DOI: 10.1111/sdi.12953.
[2] 韩晓敏,汪良,李文成,等. 肾结石并脓肾致脓毒症及弥漫性腹膜炎1例并文献复习[J]. 临床泌尿外科杂志,2011,26(11):804-805. DOI:10.3969/j.issn.1001-1420.2011.11.003.
[3] Quaresima S, Manzelli A, Ricciardi E, et al. Spontaneous intraperitoneal rupture of pyonephrosis in a patient with unknown kidney carcinosarcoma: a case report[J]. World J Surg Oncol, 2011 Apr 12;9:39. doi: 10.1186/1477-7819-9-39. PMID: 21486444; PMCID: PMC3087700.
[4] Nema S, Brahmachari S. Pyonephrosis by Prevotella disiens and Escherichia coli coinfection and secondary peritonitis in an obstructive uropathy patient: A case report and review of the literature[J]. J Family Med Prim Care, 2020 Feb 28;9(2):1263-1265. DOI: 10.4103/jfmpc.jfmpc_907_19.
[5] Wen YK. Secondary peritonitis due to rupture of pyonephrosis after ureteroscopy in a peritoneal dialysis patient[J] .Clin Nephrol,2022, 98(1):62-64. DOI: 10.5414/CN110779.
[6] Dhruve MJ, Bargman JM. Klebsiella pneumoniae Renal Abscess and Peritonitis in a Peritoneal Dialysis Patient: A Novel Route of Infection[J].Perit Dial Int,2017,37(6):654-656. DOI: 10.3747/pdi.2017.00094.
[8] 周福德,廖永贤,李超亮,等. 持续非卧床式腹膜透析患者合并继发性腹膜炎[J]. 中国血液净化,2008,7(6):303-306. DOI:10.3969/j.issn.1671-4091.2008.06.005.
