Genital and Anterior Abdominal Wall Edema

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Labial, scrotal and penile edema occur in approximately 10% of PD patients and is more frequent in men.  The mechanisms include pericatheter leaks, peritoneo-fascial defects and patent processus vaginalis. 

 

The presence of anterior abdominal wall edema, and particularly asymmetry of the abdomen, suggests a pericatheter leak and dissection of dialysate into the abdominal wall. 

 

Diagnosis.  Abdominal scintigraphy with technetium⁹⁹ or computerized tomographic scanning with contrast can readily identify a patent processus vaginalis or a pericatheter leak. 

 

 

         

Patent processus vaginalis

Scintigram showing patent processus vaginalis (arrow).

 

 

 

Pseudohernia

Used with permission from reference 1.

 

Asymmetrical pericatheter edema of the anterior abdominal wall due to pericatheter leak at the site of the internal cuff.

 

Treatment.  Conservative treatment consists of bed rest and the use of frequent, low volume exchanges in the supine position.  A patent processus vaginalis usually requires surgical obliteration.  A persistent pericatheter leak is best treated with reinforcement of the purse-string suture around the internal cuff of the catheter.

 

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Reference:

1. Diaz-Buxo JA, Geissinger WT. Single cuff versus double cuff Tenckhoff catheter. Perit Dial Bull 4:S100-S102, 1984