Successful Conservative Management of Scrotal Edema Resulting from Uncomplicated Peritoneal Fluid Leak

Abstract

Introduction: Peritoneal fluid leaks are frequent in continuous ambulatory peritoneal dialysis (CAPD) patients and may manifest as subcutaneous or genital edema or as apparent ultrafiltration (UF) failure. Genital swelling in CAPD patients is often due to dialysate leak through a small clinically-undetectable inguinal hernia, and may require herniorrhaphy. If imaging studies exclude an associated hernia or patent processus vaginalis, a conservative approach may be adopted.
Case report: An 80 year-old bed-ridden male developed gross bilateral scrotal swelling (without cough impulse) and apparent UF failure shortly after initiation of CAPD. Computed tomography peritoneography (CTP) showed bilateral scrotal fluid collections without a hernia or patent processus vaginalis. An attempt to maintain the patient on CAPD by reducing the dialysate volume, scrotal elevation and adopting a supine position was not successful; CAPD was substituted with temporary hemodialysis (HD) for four weeks. Scrotal swelling reversed after one week of CAPD cessation and did not recur when supine PD with intermittent dry periods was reinstituted a few weeks later. Satisfactory UF could also be easily attained. This was compatible with caudal fluid migration through peritoneal defects being the underlying cause. The patient had been successfully maintained on CAPD for the last 18 months.
Conclusion: Fluid dissection through soft tissues can result in gross genital edema and apparent ultrafiltration failure in CAPD patients. Supine PD, scrotal elevation with intermittent dry periods may be a practical alternative management in the absence of automated dialysis facilities. The severity of dialysate leak does not preclude a satisfactory response to this conservative management.

Keywords: peritoneal dialysis, dialysate leak, genital edema, ultrafiltration failure