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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Continuous ambulatory peritoneal dialysis &#40;CAPD&#41; is used as an alternative to hemodialysis and has very few complications which include abdominal hernia&#44; peritonitis&#44; processus vaginalis&#44; pleural leakage&#44; and those related to the catheter exit site&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> It may occasionally be complicated by leakage of dialysate fluid into the abnormal sites&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">2&#44;3</span></a> We report a case of a woman who experienced vaginal leakage during CAPD and after peritonitis&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 24 year old female patient was diagnosed with end stage renal disease during pregnancy&#46; There was no other etiological factor&#44; but hypertension&#46; Patient was recommended 20<span class="elsevierStyleHsp" style=""></span>hours of hemodialysis&#44; but she refused and gave birth to a living child on the 38th gestational week&#46; She has been on CAPD for the last 3 months&#46; Since last week she has started to have abdominal pain accompanied with nausea and fever &#40;&#62;38<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#46; With these complaints she was referred to our policlinic and her peritoneal fluid cell count was found 4860&#47;mm<span class="elsevierStyleSup">3</span> &#40;95&#37; polymorphonuclear leukocytes&#41;&#46; Cultures were obtained and she was admitted to our hospital with the diagnosis of peritonitis&#46; Blood analysis showed leucocytes 9000&#47;mm<span class="elsevierStyleSup">3</span>&#44; hemoglobin&#58; 8&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;dl &#40;11&#46;5&#8211;16&#41;&#44; C-reactive protein&#58; 14&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;0&#8211;0&#46;5&#41;&#44; sedimentation&#58; 135<span class="elsevierStyleHsp" style=""></span>mm&#47;hour&#46; <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> was detected in blood cultures&#46; She was on empiric ceftazidime and cefazolin treatment and treatment was continued because <span class="elsevierStyleItalic">P&#46; aeruginosa</span> was found sensitive to this treatment&#46; Urine culture remained sterile&#46; Patient stated that there is dialysate in her vagina&#46; She was consulted with obstetrics and gynecology regarding any fistulas&#46; A urine catheter was placed and it is understood that origin of dialysate was vagina&#46; Contrast enhanced computerized tomography was done showing a vaginal fistula &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; CAPD catheter was removed&#46; Surgical operation was found unnecessary and hemodialysis was started&#46; Patient was discharged after 3 weeks of ant biotherapy&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Patients on CAPD have an increased risk of both hernia formation and dialysate leakage as an intraperitoneal pressure related complications&#46; One of the rare peritoneal fluid leakage is through processus vaginalis<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> and main mechanisms include leakage through the fallopian tube and then the uterus and vagina&#44; or leakage through a fistula between the uterus and the peritoneal cavity formed after surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> One of the reason for fistula formation is peritonitis which is often caused by skin bacteria penetration via transvisceral&#44; transvaginal or hematogenous spread of organisms&#44; and the CAPD catheter can become colonized by bacteria creating a biofilm that repeatedly seeds the peritoneum&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In our case&#44; a rare entity&#59; vaginal fistula and also another rarely seen clinic&#59; peritonitis secondary to vaginal fluid were present&#46; Probably secondary to the fistula&#44; peritonitis developed and after peritonitis&#44; fluid from fistula tract has increased and caused vaginal leakage&#46;</p></span>"
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Letter to the Editor
An unusual case of peritonitis after vaginal leak in a patient on peritoneal dialysis
Un caso infrecuente de peritonitis tras fuga vaginal en un paciente en diálisis peritoneal
Ali Bakan, Alihan Oral
Autor para correspondencia
dr.alihanoral@gmail.com

Corresponding author.
, Osman Kostek, Sabahat Alışır Ecder, Ali Rıza Odabaş
Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Internal Medicine, Kadiköy, Istanbul, Turkey
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Información del artículo
ISSN: 02116995
Idioma original: Inglés
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