Peritoneal dialysis catheter dysfunction is one of the main complications of peritoneal dialysis. The most common causes of infusion and/or drainage problems are caused by catheter migration or kinking, constipation, fibrin deposition, intraperitoneal adhesions or omentum entrapment.

We present a case of peritoneal catheter obstruction due to entrapment by the fallopian tube and solving the problem by laparoscopy.

This was a 62-year-old patient with CKD stage 5 of unknown cause. Laparoscopy was performed to implant a self-positioning catheter, without incident either during surgery or postoperatively. Follow-up abdomen X-ray showed the tip of the catheter optimally positioned in the lower pelvis. Infusions were started with progressively larger volumes seven days after the intervention. A very slow flow was observed during the infusion and difficulty in drainage, not recovering the infused volume. Repeat abdominal X-ray showed no changes compared to the previous one. Laxatives and enemas were prescribed, and mobilisation was advised. Despite the patient having abundant, daily bowel movements, the infusion and drainage problems persisted, preventing the technique from being started. Iodine contrast was infused through the catheter and by contrast fluoroscopy the contrast was observed at the distal end of the catheter with images suggesting omentum entrapment (Fig. 1). Diagnostic laparoscopy was performed, but showed no omentum involvement. Entrapment of the catheter was found by the fimbriae of the left fallopian tube, which had surrounded the distal end of the catheter, blocking the exit holes. The catheter was released, its lumen was cleared out using a guidewire and flushing with normal saline, with large amounts of fibrin being found inside the catheter. After seven days the technique was restarted, the catheter functioning correctly with adequate infusion and drainage volumes.

Fig. 1.

Fluoroscopic peritoneogram with output of contrast from the distal end of the catheter.

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Mechanical obstruction or malpositioning of the catheter are complications that prevent the proper functioning of peritoneal dialysis. The incidence of catheter dysfunction due to mechanical problems varies from 2% to 36% depending on the series, but decreases with the implementation of laparoscopy as an insertion technique.1,2 Omentum entrapment is a common cause of catheter obstruction, but entrapment by intraperitoneal structures such as the appendix3 or the fallopian tube, although rare, are other possible mechanisms of blockage of the flow of fluid.4,5 Obstruction by the fallopian tube fimbriae is a very rare cause of mechanical catheter dysfunction. It may occur asymptomatically as in our case, but sometimes it may manifest clinically with pain in the iliac area and vaginal fluid leakage.6 Laparoscopy is the technique of choice for diagnosis and treatment, enabling the viability of the catheter to be restored and have the dialysis procedure restarted.7 Despite being a rare cause of dysfunction, we should assess the possibility of catheter entrapment by the fallopian tube in women on the peritoneal dialysis programme.