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Conference Paper: A hemodialysis patient with severe vomiting
Title | A hemodialysis patient with severe vomiting |
---|---|
Authors | |
Issue Date | 2009 |
Publisher | Blackwell Publishing, Inc. The Journal's web site is located at http://www.blackwellpublishing.com/journals/HDI |
Citation | The 2nd Congress of International Society for Hemodialysis (ISHD 2009), Hong Kong, 28-30 August 2009. In Hemodialysis International, 2009, v. 13 n. 3, p. 432-433 How to Cite? |
Abstract | A 59-year-old lady, who had switched to hemodialysis for 4 years
after a severe continuous ambulatory peritoneal dialysis (CAPD)
peritonitis, complained of repeated vomiting. She had significant
weight loss secondary to poor oral intake. There was no other
associated gastrointestinal symptom. She was adequately dialyzed
with KT/V 4.58/week. Drug history was carefully reviewed and no
emetic drug identified. Esophagogastroscopy showed reflux
esophagitis (grade B). X-ray of the abdomen was unremarkable.
However, computer tomography showed dilated stomach and
proximal small bowel. There was also large amount of peritoneal
fluid collection with possible compression in superior mesenteric
artery (SMA) region resulting in obstruction equivalent to SMA
syndrome (Figure 1). Barium meal and follow-through showed a
delay in transit through the duodenum with dilated D1 and D2
and indentation at D3, compatible with partial duodenal obstruction
secondary to intra-abdominal collection (Figure 2). Aspiration
of the intra-abdominal collection was performed repeatedly.
However, the patients’ symptoms persisted. Insertion of nasojejunal
feeding tube under esophagogastroscopy guidance was attempted
twice to bypass the obstruction but the feeding tube
slipped out. Finally the patient underwent laparotomy and gastrojejunostomy.
Postoperatively, the patient could tolerate oral
feeding with no significant vomiting. Vomiting is a common complaint
in dialysis patient. Differential diagnosis of vomiting includes
functional vomiting, effect of uremia, drug effect, and upper gastrointestinal obstruction such as SMA syndrome. In
patient with history of refractory CAPD peritonitis, mechanical
obstruction secondary to loculated intra-abdominal collection or
adhesion needs to be suspected. Our case demonstrated that
intra-abdominal collection could take place up to 4 years after
termination of peritoneal dialysis. |
Description | Conference Theme: From Hemodialysis Unit to ICU |
Persistent Identifier | http://hdl.handle.net/10722/224397 |
ISSN | 2023 Impact Factor: 1.2 2023 SCImago Journal Rankings: 0.425 |
DC Field | Value | Language |
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dc.contributor.author | Ma, KM | - |
dc.contributor.author | Yap, YHD | - |
dc.contributor.author | Chan, DTM | - |
dc.contributor.author | Lai, KN | - |
dc.date.accessioned | 2016-04-01T08:00:10Z | - |
dc.date.available | 2016-04-01T08:00:10Z | - |
dc.date.issued | 2009 | - |
dc.identifier.citation | The 2nd Congress of International Society for Hemodialysis (ISHD 2009), Hong Kong, 28-30 August 2009. In Hemodialysis International, 2009, v. 13 n. 3, p. 432-433 | - |
dc.identifier.issn | 1492-7535 | - |
dc.identifier.uri | http://hdl.handle.net/10722/224397 | - |
dc.description | Conference Theme: From Hemodialysis Unit to ICU | - |
dc.description.abstract | A 59-year-old lady, who had switched to hemodialysis for 4 years after a severe continuous ambulatory peritoneal dialysis (CAPD) peritonitis, complained of repeated vomiting. She had significant weight loss secondary to poor oral intake. There was no other associated gastrointestinal symptom. She was adequately dialyzed with KT/V 4.58/week. Drug history was carefully reviewed and no emetic drug identified. Esophagogastroscopy showed reflux esophagitis (grade B). X-ray of the abdomen was unremarkable. However, computer tomography showed dilated stomach and proximal small bowel. There was also large amount of peritoneal fluid collection with possible compression in superior mesenteric artery (SMA) region resulting in obstruction equivalent to SMA syndrome (Figure 1). Barium meal and follow-through showed a delay in transit through the duodenum with dilated D1 and D2 and indentation at D3, compatible with partial duodenal obstruction secondary to intra-abdominal collection (Figure 2). Aspiration of the intra-abdominal collection was performed repeatedly. However, the patients’ symptoms persisted. Insertion of nasojejunal feeding tube under esophagogastroscopy guidance was attempted twice to bypass the obstruction but the feeding tube slipped out. Finally the patient underwent laparotomy and gastrojejunostomy. Postoperatively, the patient could tolerate oral feeding with no significant vomiting. Vomiting is a common complaint in dialysis patient. Differential diagnosis of vomiting includes functional vomiting, effect of uremia, drug effect, and upper gastrointestinal obstruction such as SMA syndrome. In patient with history of refractory CAPD peritonitis, mechanical obstruction secondary to loculated intra-abdominal collection or adhesion needs to be suspected. Our case demonstrated that intra-abdominal collection could take place up to 4 years after termination of peritoneal dialysis. | - |
dc.language | eng | - |
dc.publisher | Blackwell Publishing, Inc. The Journal's web site is located at http://www.blackwellpublishing.com/journals/HDI | - |
dc.relation.ispartof | Hemodialysis International | - |
dc.rights | The definitive version is available at www.blackwell-synergy.com | - |
dc.title | A hemodialysis patient with severe vomiting | - |
dc.type | Conference_Paper | - |
dc.identifier.email | Yap, YHD: desmondy@hku.hk | - |
dc.identifier.email | Chan, DTM: dtmchan@hku.hk | - |
dc.identifier.email | Lai, KN: knlai@hku.hk | - |
dc.identifier.authority | Yap, YHD=rp01607 | - |
dc.identifier.authority | Chan, DTM=rp00394 | - |
dc.identifier.authority | Lai, KN=rp00324 | - |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1111/j.1542-4758.2009.00402.x | - |
dc.identifier.hkuros | 180825 | - |
dc.identifier.volume | 13 | - |
dc.identifier.issue | 3 | - |
dc.identifier.spage | 432 | - |
dc.identifier.epage | 433 | - |
dc.publisher.place | United States | - |
dc.identifier.issnl | 1492-7535 | - |