Computerized Tomography With and Without Intraperitoneal Contrast for Determination of Intraabdominal Fluid Distribution and Diagnosis of Complications in Peritoneal Dialysis Patients
Seven computed tomography scans and 19 computed tomograph peritoneography (CTP) studies performed in 20 peritoneal dialysis patients were analyzed retrospectively as to their diagnostic usefulness in peritoneal dialysis related complications. Computed tomographic peritoneography was found to be superior to computed tomography scans in localizing small leak sites. In seven of nine patients with clinically diagnosed dialysate leakage, computed tomographic peritoneography supported the clinical diagnosis and localized the leak site in six patients. All patients with a conspicuous leak site and/or with leaks through hernias had to have surgical treatment. Computed tomographic peritoneography failed to reveal a leak or identify a fluid tract in patients with intermittent, small leaks. Those leaks responded easily to a dialysis regimen with diminished intraabdominal pressure. Normal intraperitoneal fluid distribution was based on 17 studies after intraperitoneal infusion of 2,000 ml of peritoneal dialysis solution in patients without intraabdominal organomegaly and/or any clinical suspicion of fluid maldistribution, with average peritoneal transport characteristics. As appraised in the supine position, approximate fluid contents in the intraperitoneal spaces were pelvis, 30–55%; paracolic gutter, 15–30%; perisplenic and perihepatic, 10–20% each, and lesser sac, 1–3%. Severe fluid maldistribution on computed tomography peritoneography, particularly a small fluid volume in the pelvic space, is a poor prognostic sign as to the feasibility of peritoneal dialysis; neither of our two patients with no fluid in the pelvic space could be maintained on peritoneal dialysis, while patients with no fluid in the lesser sac, perihepatic and perisplenic spaces could be maintained on peritoneal dialysis. No fluid was seen in the peritoneal cavity after drainage in the vertical position. Computed tomographic peritoneography was also found useful for catheter localization in relation to fluid spaces. Potential uses of CTP include: detection of intraabdominal abcesses and other loculated intraabdominal fluid collections, diagnosis of retroperitoneal and intraperitoneal tumors, organomegaly, renal cysts and carcinomas, pancreatitis, hernias, and other problems.