Case 3-2013: A 72-year-old woman with abdominal pain and distention after peritoneal dialysis

摘要

Dr. Ada Stefanescu (Medicine): A 72-year-old woman with end-stage renal disease (ESRD) was admitted to this hospital because of nausea, vomiting, and abdominal pain and distention. The patient had been receiving continuous ambulatory peritoneal dialysis for 18 months for ESRD presumed to be due to diabetic nephropathy. Six weeks before the patient was admitted, the dialysis catheter reportedly became occluded. A tunneled hemodialysis catheter was inserted in the right chest wall, and hemodialysis three times weekly was begun at another facility. During the next few weeks, nausea and vomiting developed and were associated with an unspecified loss of weight. Seventeen days before admission, the patient was evaluated in an outpatient clinic at this hospital for removal of the peritoneal catheter and for creation of an arterio-venous fistula. Laboratory-test results are shown in Table 1. Venograms of the arms were normal.