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Appendiceal Incarceration by Peritoneal Dialysis Catheter

Editor: A 60-year-old woman with chronic renal failure secondary to anti-neutrophil cytoplasmic antibodies (ANCA)-positive glomerulonephritis presented to our emergency department with 24 hours of right iliac fossa abdominal pain. She had been on peritoneal dialysis (PD) intermittently for 2 years prior, via a coiled Tenchkoff catheter placed using a percutaneous Seldinger technique. However, her renal function and fluid retention had worsened despite switching from continuous ambulatory PD to automated PD. Hemodialysis via permacath had been commenced 3 weeks prior to admission, with the Tenchkoff catheter left in-situ at the patient’s request. On admission, our patient had localized guarding in the right iliac fossa, but was systemically well. White cell count was normal, with C-reactive protein mildly raised. Computed tomography (CT) demonstrated the coiled Tenchkoff catheter in the region of the appendix with mild surrounding stranding and adjacent fluid (Figure 1). Intravenous antibiotics were commenced. The following day, laparoscopy was performed, demonstrating the catheter coiled tightly around the cecal pole, constricting the base of the appendix (Figure 2). The appendix was swollen and erythematous, with surrounding suppurative fluid, but no necrosis or perforation. The catheter was removed laparoscopically, as was the appendix. Our patient recovered well, being discharged day 2 postoperatively. She had a brachiocephalic fistula created and continues to this day on hemodialysis.