Development and validation of a nomogram for predicting refractory peritoneal dialysis related peritonitis.

OBJECTIVE: To identify the risk factors of refractory peritoneal dialysis related peritonitis (PDRP) and construct a nomogram to predict the occurrence of refractory PDRP. METHODS: Refractory peritonitis was defined as the peritonitis episode with persistently cloudy bags or persistent dialysis effluent leukocyte count >100 × 109/L after 5 days of appropriate antibiotic therapy. The study dataset was randomly divided into a 70% training set and a 30% validation set. Univariate logistic analysis, LASSO regression analysis, and random forest algorithms were utilized to identify the potential risk factors for refractory peritonitis. Independent risk factors identified using multivariate logistic analysis were used to construct a nomogram. The discriminative ability, calibrating ability, and clinical practicality of the nomogram were evaluated using the receiver operating characteristic curve, Hosmer-Lemeshow test, calibration curve, and decision curve analysis. RESULTS: A total of 294 peritonitis episodes in 178 patients treated with peritoneal dialysis (PD) were enrolled, of which 93 were refractory peritonitis. C-reactive protein, serum albumin, diabetes mellitus, PD duration, and type of causative organisms were independent risk factors for refractory peritonitis. The nomogram model exhibited excellent discrimination with an area under the curve (AUC) of 0.781 (95% CI: 0.716-0.847) in the training set and 0.741 (95% CI: 0.627-0.855) in the validation set. The Hosmer-Lemeshow test and calibration curve indicated satisfactory calibration ability of the predictive model. Decision curve analysis revealed that the nomogram model had good clinical utility in predicting refractory peritonitis. CONCLUSION: This nomogram can accurately predict refractory peritonitis in patients treated with PD.

Abdominal wound closure in the presence of sepsis: our experience with the use of subcutaneous drain.

Objectives: Patients requiring surgery for secondary peritonitis demonstrate a significantly increased risk for incisional surgical site infection. This study aimed to evaluate the efficacy of subcutaneous wound drain post-laparotomy for contaminated surgical wounds. Design: This was a prospective comparative hospital-based study. Setting: Patients who had surgery for secondary peritonitis in Irrua Specialist Teaching Hospital were studied. Participants: Fifty patients aged 16 years and above who presented with secondary peritonitis. Intervention: Patients who met the inclusion criteria were randomized into two equal groups. Group A had a suction drain placed in the subcutaneous space after laparotomy while Group B did not. Main outcome measures: Development of incisional surgical site infection, wound dehiscence, and duration of post-operative hospital stay. Results: The incidence of incisional surgical site infection was significantly less in Group A (20%) than in Group B (68%). There was no case of wound dehiscence in Group A as against 3 (12%) in Group B. The difference was not statistically significant. The mean duration of hospital stay was significantly less with subcutaneous suction drain (8.96+2.81 Vs 14.04+8.05; p = 0.005). Conclusion: Subcutaneous suction drainage is beneficial in abdominal wall closure in cases of peritonitis as it significantly reduces the incidence of incisional surgical site infection and the duration of postoperative hospital stay. The reduction in surgical wound dehiscence observed in this study was, however, not statistically significant. Funding: None declared.

Aspergillus fumigatus Postoperative Fasciitis and Peritonitis.

A 67 year-old male was admitted in the ICU because of multi-organ failure due to sepsis secondary to Fournier's gangrene. He had sustained radical prostatectomy in the last 48 hours. Peritoneal fluid and fatty tissue biopsies grew Aspergillus Fumigatus without concomitant pulmonary involvement. Postoperative acquisition via exogenous and endogenous routes is discussed, as this nosocomial entity is very rarely reported apart from peritoneal dialysis, especially in non-immunosuppressed patients.

[Pyogenic hepatic abscess secondary to gastric perforation by a foreign body complicated by acute peritonitis: about a case at the Hôpital Principal de Dakar, Senegal]. / Abcès hépatiques à pyogènes secondaires à une perforation gastrique par un corps étranger compliquée de péritonite aiguë : à propos d'un cas à l'Hôpital Principal de Dakar, Sénégal.

Accidental ingestion of a foreign body into the gastrointestinal tract is not uncommon, however the development of hepatic abscesses secondary to digestive perforation by a foreign body is rare. We report the case of pyogenic hepatic abscesses secondary to gastric perforation by a fishbone complicated by acute peritonitis. A 53-year-old patient was admitted to our hospital with the main complaints: diffuse abdominal pain with vomiting in a context of fever and physical asthenia. A painful febrile hepatomegaly with jaundice was objectified, as well as a non-specific biological inflammatory syndrome. An initial abdominopelvic CT scan revealed multifocal liver abscesses. Faced with the initial therapeutic failure associating parenteral antibiotic therapy and abscess drainage, a second abdominal CT scan identified a foreign body straddling the antropyloric wall and segment I of the liver.A xypho-pelvic midline laparotomy was performed with nearly 200 cc of peritoneal fluid coming out. A fishbone approximately 5 cm long was extracted by laparotomy, followed by gastric closure with omentum, peritoneal cleansing and drainage. Symptomatic adjuvant treatment was initiated, including a proton pump inhibitor (Pantoprazole). He also benefited from transfusion support in the face of anemia. Antibiotic therapy was continued for a total of 2 weeks after surgery. The evolution was favorable with follow-up imaging at 3 months, showing complete resorption of the hepatic abscesses.

Abdominal cocoon syndrome (sclerosing encapsulated peritonitis) causing small bowel occlusion in a patient with gastric bypass.

A rare condition, sclerosing encapsulating peritonitis, is characterized by a fibrotic membrane forming over the bowels, leading to intestinal obstruction. In this case of a 56-year-old male patient with a history of laparoscopic gastric bypass, a computed tomography scan showed findings indicative of the condition. Extensive adhesiolysis was performed, and biopsies confirmed the presence of fusiform cells (D2-40 positive on immunochemistry) resembling fibroblasts, within dense collagenous peritoneal tissue sheets, typical of sclerosing encapsulating peritonitis. The prevalence of this condition is uncertain, and diagnosis typically requires a peritoneal biopsy due to the nonspecific clinical presentation.

La peritonitis esclerosante encapsulada es una condición rara caracterizada por una membrana fibrótica que se genera sobre las asas intestinales causando cuadros de oclusión intestinal. Se presenta el caso de un paciente varón de 56 años con antecedente de derivación gastroyeyunal por laparoscopia que presenta oclusión intestinal. Se realizó tomografía computada que evidenció sitio de transición previo al sitio de anastomosis. Se realizó de anastomosis extensa y toma de biopsias. Histológicamente se observó engrosamiento de la membrana peritoneal, células fusiformes (D2-40 positivo en inmunohistoquímica) similares a fibroblastos con láminas de colágeno peritoneal denso. La peritonitis esclerosante encapsulada es una patología de prevalencia desconocida. El cuadro clínico es inespecífico y el diagnóstico definitivo es por patología con biopsia peritoneal.

Prognostic Factors of Peritonitis in Patients on Peritoneal Dialysis: a Retrospective Observational Study.

Background/Objectives. Peritoneal dialysis stands as an established form of renal replacement therapy; yet peritonitis remains a major complication associated with it. This study, analyzing two decades of data from the Nephrology, Dialysis, and Hypertension Division of the University-Hospital IRCCS in Bologna, aimed to identify prognostic factors linked to peritonitis events. It also sought to evaluate the suitability of different peritoneal dialysis techniques, with a focus on Automated Peritoneal Dialysis (APD) and Continuous Ambulatory Peritoneal Dialysis (CAPD). Additionally, the study assessed the impact of an educational program introduced in 2005 on peritonitis frequency. Methods. Conducting an observational, retrospective, single-center study, 323 patients were included in the analysis, categorized based on their use of APD or CAPD. Results. Despite widespread APD usage, no significant correlation was found between the dialysis technique (APD or CAPD) and peritonitis onset. The analysis of the educational program's impact revealed no significant differences in peritonitis occurrence. However, a clear relationship emerged between regular patient monitoring at the reference center and the duration of peritoneal dialysis. Conclusions. Despite the absence of a distinct association between peritonitis onset and dialysis technique, regular patient monitoring at the reference center significantly correlated with prolonged peritoneal dialysis duration.

Pantoea dispersa peritoneal dialysis catheter-related infection.

Enteric gram-negative bacteria-associated peritoneal dialysis (PD) peritonitis is common. These organisms are such as Escherichia coli, Klebsiella and Enterobacter species. Pantoea dispersa belongs to the order Enterobacterales, it has known benefits and a role in agricultural and environmental biotechnology. Pantoea dispersa, although still relatively rare, is being increasingly recognised to cause human infections. We are reporting a case of PD peritonitis caused by Pantoea dispersa in a kidney failure patient on continuous ambulatory peritoneal dialysis (CAPD). His peritonitis was treated well with intraperitoneal antibiotics and the patient can resume his CAPD therapy. The increasing reports of Pantoea dispersa-related human infections warrant concerns, both in immunocompromised and immunocompetent patients.

[Successful treatment of severe purulent peritonitis against the background of intraperitoneal hypertension syndrome (clinical case)]. / Uspeshnoe lechenie tyazhelogo gnoinogo peritonita na fone sindroma vnutribryushnoi gipertenzii (klinicheskii sluchai).

Traditional surgical treatment of widespread purulent peritonitis has some disadvantages that emphasizes the need for new approaches to postoperative care. The authors present successful treatment of diffuse purulent peritonitis using a combination of 'open abdomen' technology and VAC therapy. This approach reduces abdominal inflammation and intra-abdominal pressure. Combination of 'open abdomen' technology and VAC therapy provides effective control of inflammation and stabilization of patients with purulent peritonitis.

Rare Pathogens in Peritoneal Dialysis-Associated Peritonitis: A Comprehensive Case Study and Guideline Review.

BACKGROUND Peritoneal dialysis (PD) serves as a critical renal replacement therapy for individuals with end-stage renal disease (ESRD), leveraging the peritoneum for fluid and substance exchange. Despite its effectiveness, PD is marred by complications such as peritonitis, which significantly impacts patient outcomes. The novelty of our report lies in the presentation of a rare case of PD-associated peritonitis caused by 2 unusual pathogens, emphasizing the importance of rigorous infection control measures. CASE REPORT We report on an 80-year-old African-American female patient with ESRD undergoing PD, who was admitted twice within 8 months for non-recurring episodes of peritonitis. These episodes were attributed to the rare pathogens Achromobacter denitrificans/xylosoxidans and Carbapenem-resistant Acinetobacter baumannii. Despite presenting with similar symptoms during each episode, such as abdominal pain and turbid dialysis effluent, the presence of these uncommon bacteria highlights the intricate challenges in managing infections associated with PD. The treatment strategy encompassed targeted antibiotic therapy, determined through susceptibility testing. Notably, the decision to remove the PD catheter followed extensive patient education, ensuring the patient comprehended the rationale behind this approach. This crucial step, along with the subsequent shift to hemodialysis, was pivotal in resolving the infection, illustrating the importance of patient involvement in the management of complex PD-related infections. CONCLUSIONS This case underscores the complexities of managing PD-associated peritonitis, particularly with uncommon and resistant bacteria. It emphasizes the importance of rigorous infection control measures, the need to consider atypical pathogens, and the critical role of patient involvement in treatment decisions. Our insights advocate for a more informed approach to handling such infections, aiming to reduce morbidity and improve patient outcomes. The examination of the literature on recurrent peritonitis and treatment strategies provides key perspectives for navigating these challenging cases effectively.

A descriptive analysis of skin-only closure and Bogota bag techniques for achieving complete fascial closure in damage control abdominal surgery.

BACKGROUND: Temporary abdominal closure (TAC) techniques are essential in managing open abdomen cases, particularly in damage control surgery. Skin-only closure (SC) and Bogota bag closure (BBC) are commonly used methods for TAC, but their comparative effectiveness in achieving primary fascial closure (PFC) remains unclear. The objective of this study was to evaluate the rates of PFC between patients undergoing SC and BBC techniques for TAC in peritonitis or abdominal trauma cases at a tertiary care hospital. METHODS: A retrospective cross-sectional study was conducted at the Surgical A Unit of Hayatabad Medical Complex, Peshawar, from January 2022 to July 2023. Approval was obtained from the institutional review board, and patient consent was secured for data use. Patients undergoing temporary abdominal closure using either skin-only or Bogota bag techniques were included. Exclusions comprised patients younger than 15 or older than 75 years, those with multiple abdominal wall incisions, and those with prior abdominal surgeries. Data analysis utilized SPSS version 25. The study aimed to assess outcomes following damage control surgery, focusing on primary fascial closure rates and associated factors. Closure techniques (skin-only and Bogota bag) were chosen based on institutional protocols and clinical context. Indications for damage control surgery (DCS) included traumatic and non-traumatic emergencies. Intra-abdominal pressure (IAP) was measured using standardized methods. Patients were divided into SC and BBC groups for comparison. Criteria for reoperation and primary fascial closure were established, with timing and technique determined based on clinical assessment and multidisciplinary team collaboration. The decision to leave patients open during the index operation followed damage control surgery principles. RESULTS: A total of 193 patients were included in this study, with 59.0% undergoing skin-only closure (SC) and 41.0% receiving Bogota bag closure (BBC). Patients exhibited similar demographic characteristics across cohorts, with a majority being male (73.1%) and experiencing acute abdomen of non-traumatic origin (58.0%). Among the reasons for leaving the abdomen open, severe intra-abdominal sepsis affected 51.3% of patients, while 42.0% experienced hemodynamic instability. Patients who received SC had significantly higher rates of primary fascial closure (PFC) compared to BBC (85.1% vs. 65.8%, p = 0.04), with lower rates of fascial dehiscence (1.7% vs. 7.6%, p = 0.052) and wound infections (p = 0.010). Multivariate regression analysis showed SC was associated with a higher likelihood of achieving PFC compared to BBC (adjusted OR = 1.7, 95% CI: 1.3-3.8, p < 0.05). CONCLUSION: In patients with peritonitis or abdominal trauma, SC demonstrated higher rates of PFC compared to BBC for TAC in our study population. However, further studies are warranted to validate these results and explore the long-term outcomes associated with different TAC techniques.

[Cuff Shaving in Recurrent Exit-Site Infections in a Patient on Peritoneal Dialysis].

In patients on peritoneal dialysis, the cutaneous emergency (exit-site) represents a potential access route to the peritoneum; consequently, it can become a site for microbial infections. These infections, initially localized to the exit-site, may spread to the peritoneum causing peritonitis, which is the most common cause of drop-out from peritoneal dialysis and transition to hemodialysis. Peritoneal catheters have dacron caps which have the function of counteracting the traction of the catheter itself and at the same time acting as a barrier for microorganisms, preventing the spread towards the peritoneum. Despite this, the same dacron cap can represent a sort of nest for microorganisms to colonize and, with the formation of a biofilm that facilitates their proliferation, make the same organisms impervious to antibiotic therapy and even resistance to them. The most effective tool for monitoring the health status of the exit-site is represented by the objective examination. This examination, through the use of well-defined scales, helps to provide a pathological score of the exit, facilitating the implementation of necessary precautions. In the presence of recurrent exit-site infections, from both Gram positive and Gram negative bacteria, minimally invasive surgical therapy is a valid approach to break this vicious circle. It helps avoid subjecting the patient to the removal of the peritoneal catheter, temporary transition to hemodialysis with the insertion of a central venous catheter, and subsequent repositioning of another peritoneal catheter. We propose the case of a recurrent Staphylococcus Aureus infection resolved after cuff shaving of the exit-site.

Peritoneal dialysis related peritonitis: insights from a long-term analysis of an Italian center.

BACKGROUND: Peritonitis is a common and severe complication of peritoneal dialysis (PD). For comparative analysis standardized definitions as well as measurements and outcomes are crucial. However, most PD-related peritonitis studies have been using heterogenous definitions and variable methods to measure outcomes. The ISPD 2022 guidelines have revised and clarified numerous definitions and proposed new peritonitis categories and outcomes. METHODS: Between 1st January 2009 and 31st May 2023, 267 patients who started PD at our institution were included in the study. All PD-related peritonitis episodes that occurred in our unit during the study period were collected. The new definitions and outcomes of ISPD 2022 recommendations were employed. RESULTS: The overall peritonitis rate was 0.25 episode/patient year. Patient cumulative probability of remaining peritonitis-free at one year was 84.2%. The medical cure and refractory peritonitis rates were equal to 70.3 and 22.4%, respectively. Culture-negative peritonitis accounted for 25.6% of all specimens. The rates of peritonitis associated death, hemodialysis transfer, catheter removal and hospitalization were 6.8%, 18.3%, 18.7% and 64.4%, respectively. Relapsing, repeat, recurrent and enteric peritonitis accounted for 7.8%, 6.8%, 4.1% and 2.7% of all episodes, respectively. Catheter insertion, catheter related and pre-PD peritonitis were 4.2, 2.1 and 0.5%. CONCLUSIONS: The implementation of PD-related peritonitis reports using standardized definitions and outcome measurements is of paramount importance to enhance clinical practice and to allow comparative studies.

Open or closed abdomen post laparotomy to control severe abdominal sepsis: a survival analysis.

INTRODUCTION: severe abdominal sepsis, accompained by diffuse peritonitis, poses a significant challenge for most surgeons. It often requires repetitive surgical interventions, leading to complications and resulting in high morbidity and mortality rates. The open abdomen technique, facilitated by applying a negative-pressure wound therapy (NPWT), reduces the duration of the initial surgical procedure, minimizes the accumulation of secretions and inflammatory mediators in the abdominal cavity and lowers the risk of abdominal compartment syndrome and its associated complications. Another approach is primary closure of the abdominal aponeurosis, which involves suturing the layers of the abdominal wall. METHODS: the objective of this study is to conduct a survival analysis comparing the treatment of severe abdominal sepsis using open abdomen technique versus primary closure after laparotomy in a public hospital in the South of Brazil. We utilized data extracted from electronic medical records to perform both descriptive and survival analysis, employing the Kaplan-Meier curve and a log-rank test. RESULTS: the study sample encompassed 75 laparotomies conducted over a span of 5 years, with 40 cases employing NPWT and 35 cases utilizing primary closure. The overall mortality rate observed was 55%. Notably, survival rates did not exhibit statistical significance when comparing the two methods, even after stratifying the data into separate analysis groups for each technique. CONCLUSION: recent publications on this subject have reported some favorable outcomes associated with the open abdomen technique underscoring the pressing need for a standardized approach to managing patients with severe, complicated abdominal sepsis.

Transitioning to peritoneal dialysis: it does not matter where you come from.

INTRODUCTION: Patients with end-stage renal disease (ESRD) frequently change renal replacement (RRT) therapy modality due to medical or social reasons. We aimed to evaluate the outcomes of patients under peritoneal dialysis (PD) according to the preceding RRT modality. METHODS: We conducted a retrospective observational single-center study in prevalent PD patients from January 1, 2010, to December 31, 2017, who were followed for 60 months or until they dropped out of PD. Patients were divided into three groups according to the preceding RRT: prior hemodialysis (HD), failed kidney transplant (KT), and PD-first. RESULTS: Among 152 patients, 115 were PD-first, 22 transitioned from HD, and 15 from a failing KT. There was a tendency for ultrafiltration failure to occur more in patients transitioning from HD (27.3% vs. 9.6% vs. 6.7%, p = 0.07). Residual renal function was better preserved in the group with no prior RRT (p < 0.001). A tendency towards a higher annual rate of peritonitis was observed in the prior KT group (0.70 peritonitis/year per patient vs. 0.10 vs. 0.21, p = 0.065). Thirteen patients (8.6%) had a major cardiovascular event, 5 of those had been transferred from a failing KT (p = 0.004). There were no differences between PD-first, prior KT, and prior HD in terms of death and technique survival (p = 0.195 and p = 0.917, respectively) and PD efficacy was adequate in all groups. CONCLUSIONS: PD is a suitable option for ESRD patients regardless of the previous RRT and should be offered to patients according to their clinical and social status and preferences.

[Vacuum-assisted laparostomy for advanced peritonitisis]. / Rol' vakuum-assistirovannoi laparostomy v lechenii rasprostranennogo peritonita.

OBJECTIVE: To evaluate the efficacy of negative pressure therapy in patients with peritonitis. MATERIAL AND METHODS: The study included 127 patients with advanced secondary peritonitis between 2019 and 2022. All patients were divided into 2 groups. All ones underwent staged sanitation of the abdominal cavity. In the first group (n=76), re-laparotomies were accompanied by skin suture only and passive abdominal drainage. The second group included patients (n=51) with open abdominal cavity strategy and negative pressure therapy (vacuum-assisted laparostomy). We analyzed the number of surgeries, postoperative complications, duration of hospital-stay and mortality. RESULTS: In the second group, there were significantly lower morbidity, mean number of surgeries and hospital-stay. In addition, incidence of fascial closure of abdominal cavity was higher and mortality rate was lower in the same group. CONCLUSION: Vacuum-assisted laparostomy in patients with advanced peritonitis can reduce the number of secondary purulent complications and mortality, as well as increase the incidence of fascial closure of abdominal cavity. This approach reduces the number of surgical interventions and duration of in-hospital treatment.

The efficacy of fluconazole for anti-fungal prophylaxis in peritoneal dialysis patients: A systematic review and meta-analysis.

INTRODUCTION AND OBJECTIVES: The efficacy of fluconazole as a prophylactic strategy in patients with chronic kidney disease (CKD) on peritoneal dialysis (PD) with prior antibiotic exposure is controversial in the current literature. This study aimed to compare a strategy of fluconazole prophylaxis versus no-prophylaxis for patients in PD on antibiotics for previous episodes of peritonitis. MATERIALS AND METHODS: We performed a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs) comparing fluconazole prophylaxis with no prophylaxis for PD-related peritonitis. The search was conducted on PubMed, EMBASE, and Cochrane Central in January 23, 2023. The outcome of interest was the occurrence of fungal peritonitis (FP). RESULTS: We included six studies (1 RCT, 5 observational) with 4515 occurrences of peritonitis, of which 1098 (24.8%) received fluconazole prophylaxis in variable doses, whereas 3417 (75.6%) did not receive prophylaxis during peritonitis episodes. Overall, fluconazole prophylaxis was associated with a lower incidence of FP (OR 0.22; 95% CI 0.12-0.41; p<0.001; I2=0%). Subgroup analysis of studies that administered daily doses of fluconazole also demonstrated a reduced incidence of FP in patients who received antifungal prophylaxis (OR 0.31; CI 0.14-0.69; p=0.004; I2=0%). CONCLUSIONS: In this meta-analysis of 4515 episodes of PD-related peritonitis, prophylaxis with fluconazole significantly reduced episodes of FP as compared with no antifungal prophylaxis.

Association between the geriatric nutritional risk index and clinical outcomes among peritoneal dialysis patients: A meta-analysis.

BACKGROUND: To identify the relationship between the geriatric nutritional risk index (GNRI) and clinical outcomes in patients receiving peritoneal dialysis (PD). METHODS: The PubMed, EBASE, Web of Science and CNKI databases were searched for available studies up to December 25, 2023. The primary outcome was all-cause mortality, and the secondary outcomes included the incidence of PD dropout, major adverse cardiac and cerebrovascular events (MACCEs), technique failure and peritonitis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were combined to evaluate the predictive value of the GNRI for the occurrence of the above endpoints. RESULTS: Ten cohort studies with 3897 patients were included. The pooled results demonstrated that a lower GNRI was significantly associated with a greater incidence of all-cause mortality (HR = 0.71, 95% CI: 0.55-0.91; P = .007). In addition, a decreased GNRI predicted the occurrence of dropout from PD (HR = 0.971, 95% CI: 0.945-0.998, P = .034) and MACCE (HR = 0.95, 95% CI: 0.92-0.98, P = .001). However, no significant associations of the GNRI with technique failure (P = .167) or peritonitis (P = .96) were observed. CONCLUSION: A low GNRI is significantly associated with poor clinical outcomes and might serve as a novel and valuable prognostic indicator among PD patients.

Higher N-terminal pro-brain natriuretic peptide level at onset of peritoneal dialysis-related peritonitis is a risk factor for technique failure.

BACKGROUND: Recent studies have suggested that the N-terminal fragment of B-type natriuretic peptide (NT-proBNP) level serve as a significant risk factor for mortality in patients with end-stage renal disease. However, the relationship between NT-proBNP levels and technique failure in peritoneal dialysis-associated peritonitis (PDAP) remains unclear. This study investigated the relationship between NT-proBNP levels at the onset of PDAP and the risk of technique failure in patients with PDAP. METHODS: A retrospective analysis was conducted on patients with PDAP from December 1, 2009, to December 31, 2021, at our peritoneal dialysis center. We recorded all demographic and baseline clinical data at the time of admission for each PDAP episode. Logistic and Cox regression analyses were performed to assess the association between NT-proBNP levels and technique failure. RESULTS: Of 485 PDAP episodes included in this study, 130 episodes of technique failure were observed. Multivariate logistic analysis revealed that hospital stay, Na and NT-proBNP levels, and peritoneal dialysate white blood cell counts on days 3 and 5 were independently associated with technique failure. The receiver operating characteristic curve demonstrated that the NT-proBNP level was a better indicator than the other four variables in indicating technique failure. In the multivariate Cox regression analysis, after adjusting for confounding factors, higher NT-proBNP levels (HR of 3.020, 95% CI 1.771, 5.150, P < 0.001) were associated with PDAP technique failure. CONCLUSIONS: This retrospective study identified the serum NT-proBNP level at the onset of PDAP as an independent risk factor for technique failure in these patients.

Postoperative Bowel Obstruction as a Rare Complication of an Abdominal Drain.

Although routine intra-abdominal drain insertion following surgery represents a common practice worldwide, its utility has been questioned during the last decades. Several comparative studies have failed to document significant benefits from routine draining, and drain insertion has been correlated with various complications as well. Drain-related complications include, but are not limited, to infection, bleeding, and tissue erosion. Herein, we present the case of a 32-year-old patient with perforated peptic ulcer and purulent peritonitis, whose postoperative course was complicated by early mechanical bowel obstruction due to an abdominal drain. A high level of clinical suspicion, along with accurate imaging diagnosis, dictated prompt removal of the drain, which resulted in immediate resolution of the patient's symptoms. We aim to increase the clinical awareness of this rare complication related to intra-abdominal drain utilization with this report.