Laproscopic salvage of omental wrapping of the continuous ambulatory peritoneal dialysis catheter.

Sir,

A 7-year-old child was diagnosed to have end stage renal disease (ESRD) and initiated on continuous ambulatory peritoneal dialysis (CAPD) by the Swan-neck double cuff Tenchkoff catheter. After 6 months, he presented with poor inflow and outflow of PD fluid. A provisional diagnosis of omental wrapping of the Tenchkoff catheter was made. Owing to the poor nutritional status, high surgical risk, and the need for immediate functional CAPD access it was decided to adopt laproscopic exploration to establish the diagnosis. Intraoperatively, omental wrapping of the catheter was confirmed and the catheter was exteriorized through one of the laproscopic ports and the omental tissue was dissected out manually and the catheter was retuned back into the peritoneal cavity. The catheter was maneuvered into the iliac fossa and secured with help of sutures to prevent migration. Immediate small-volume exchanges were initiated successfully with free in- and out-flows. The patient was discharged over next 48 hours after establishing full volume exchanges uneventfully.

The incidence of obstruction causing poor flow of dialysate has been reported to be 6.0% to 20.5 %.[1] Omental wrap is a common cause of catheter obstruction with a reported incidence of about 57%-92%.[1-3] In the above case the diagnosis of omental wrapping, a well-established complication of CAPD, was successfully managed laproscopically and the catheter was salvaged uneventfully with immediate initiation of CAPD exchanges. This technique could be especially beneficial in subjects with a poor nutritional status, high surgical risk, and in those with vascular access issues in need of continued CAPD. Current laparoscopic techniques for salvaging catheters include simple repositioning with or without catheter fixation, omentopexy, and omentectomy.[2-5] As in this case we wish to highlight that laproscopy plays a vital role in both diagnostic and therapeutic applications of CAPD and it needs to be used more frequently in correcting mechanical catheter malfunctions.