A 73-year-old woman with a history of hypertensive heart disease, hypercholesterolemia, type II diabetes, peritoneal hysterectomy due to ambulatory cystocele correction, primary hypothyroidism, trigeminal neuralgia, left adrenal insufficiency, cholecystectomy, depression 2011.
During the training period and in subsequent consultations, there was no evidence of poor performance of the technique by the patient, nor referred symptoms of pneumoperitoneum.
In March 2013, the patient came to the emergency department with a one week history of abdominal pain, diarrhea, nausea without vomiting and chills without fever.
In the physical examination of the emergency room, the patient presented pain in the deep iliac fossa, predominantly cutaneous and extremities without edema.
TA: 100/60, Fc: 94 bpm, africa, Fr: 24 rpm, Sat.O2:89%.
Analytical analysis (Hemogram, biochemistry and venous gas), chest and abdomen x-ray where peritoneal dialysis catheter well placed and pneumoperitoneum appears.
After being evaluated by the surgery service, an oral contrast CAT scan showed a significant pneumoperitoneum, without any leakage of contrast or perforation of an hollow viscera.
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After the initial nursing assessment, with the previous data and interviewing the patient, there were no problems with the technique performance.
Peritoneal dialysis was exchanged according to protocol to assess the possibility of peritoneal infection.
No signs of infection (clear peritoneal fluid) were observed. A sample of fluid was collected for culture and analysis, resulting in: leukocytes: 80/uL, thus ruling out peritoneal infection.
Given the patient's situation, the patient was admitted for observation.
It is left on an absolute diet and with serum therapy.
isolation. possibility of pneumoperitoneum being related to peritoneal dialysis technique, it is decided that the nursing staff perform peritoneal dialysis exchanges according to the schedule and after drainage, place the patient in peritoneal position Trenburg
Subsequent studies showed a decrease in pneumoperitoneum, which was resolved almost completely at discharge.
