Can aspiration provide symptom relief in pneumoperitoneum for peritoneal dialysis patients? A comprehensive case presentation and analysis

Introduction and importance: Pneumoperitoneum, the presence of free air in the peritoneal cavity, is typically a concerning finding, often associated with gastrointestinal perforation. However, in peritoneal dialysis (PD) patients, pneumoperitoneum can occur without such severe underlying pathology, frequently due to air entering during dialysis exchanges.

Case report: This case report discusses a 64-year-old male with end-stage renal disease (ESRD) on PD who presented with abdominal pain and distention. The patient reported an incident during a PD session where his dialysis bag became unusually filled with air, coinciding with the onset of symptoms. CT imaging revealed significant free intraperitoneal air, initially raising concerns for gastrointestinal perforation. However, the absence of acute symptoms and stable clinical presentation indicated a nonpathological cause. The patient underwent bedside aspiration of the pneumoperitoneum, resulting in immediate symptom relief.

Clinical discussion: Pneumoperitoneum in a PD patient requires careful evaluation to differentiate nonpathological causes from serious conditions. Accurate diagnostic assessment is crucial, and conservative management can be effective in many cases. Ensuring proper PD techniques and educating patients are key to preventing recurrence.

Conclusion: In this case, bedside aspiration was performed to relieve the patient's symptoms, demonstrating a straightforward and effective approach to managing symptomatic pneumoperitoneum.