Endoscopic treatment of obstructed peritoneal catheter

An 89-year-old Japanese woman on continuous ambulatory peritoneal dialysis presented with an obstructed peritoneal catheter (both inflow and outflow) 8 weeks after the initiation of dialysis. To investigate the cause of the catheter obstruction, we adapted a gastrofiberscope for percutaneous endoscopic gastrostomy (FP-7RBS, HOYA-Pentax, Tokyo, Japan) whose outer diameter is 2.4 mm, which is comparable to that of a Tenckhoff catheter. Endoscopic examination revealed that the catheter was obstructed with a red-colored tissue (Figure 1), suggesting a visceral organ (intestine, colon, or fallopian tube). The prolapsed tissue was gently reduced back into the peritoneal cavity under direct vision from the side hole of the Tenckhoff catheter. The catheter subsequently functioned properly and she was able to resume peritoneal dialysis. Although catheter obstruction is a frequent and serious complication in peritoneal dialysis, the available non-invasive methods for the diagnosis are limited to date. Endoscopic approach can provide us accurate diagnostic information and another strategy for the treatment of peritoneal catheter obstruction.