Indications for CT peritoneography:
(1) recurrent peritonitis
(2) poor ultrafiltration
(3) difficult fluid exchange
(4) edema of abdominal wall or genital soft tissue
(5) localized bulging of the abdomen
(6) infection at the exit site or around the catheter
Technique:
(1) Drain any intra-peritoneal dialysate.
(2) Make up a mixture of dialysate and a nonionic contrast material: 1 mg contrast material in 30 mL of dialysate for each kg body weight.
(3) Infuse the contrast-dialysate mixture aseptically.
(4) Have the patient maneuver to at least 30 minutes to distribute the infused mixture.
(5) Perform the CT scan.
(6) If negative consider repeat CT in 4 hours.
(7) When finished drain the dialysate-contrast material mixture.
Peritonitis can result in:
(1) an abscess
(2) adhesions
(3) fluid loculations
(4) pseudocyst
Difficulty in performing fluid exchange can occur due to:
(1) migration or malposition of the dialysis catheter
(2) catheter kink
(3) broken catheter
(4) intra-abdominal adhesions
Poor ultrafiltration:
(1) limited access to peritoneal surface due to adhesions
(2) catheter malposition
Edema of skin and soft tissue can occur from:
(1) cellulitis
(2) fluid leakage
Localized bulging of the abdomen can occur due to:
(1) abscess
(2) fluid leak
(3) hernia (inguinal, umbilical, ventral)
