Tranaeus et al identified risk factors for peritonitis in a patient with colonic diverticuli who is undergoing continuous peritoneal dialysis. The authors are from the Karolinska Institute and Huddinge University Hospital in Stockholm.


Patient selection: colonic diverticuli and continuous peritoneal dialysis


Peritonitis was considered as being of enteral origin if enteric bacteria (E. coli, Klebsiella sp, Proteus sp, other Enterobacteriaceae, Clostridium sp, Bacteroides sp, Enterococcus sp, Fusobacterium sp) was cultured from the dialysate fluid.


Risk factors for peritonitis of enteral origin:

(1) >= 10 diverticuli

(2) maximum diameter of a diverticulum >= 10 mm (1 cm)

(3) diverticula in ascending, transverse or descending colon (non-sigmoid colon)


Most episodes involved micro-perforations of existing diverticuli. Microperforations were more likely to have a single pathogen isolated, while a macroperforation was associated with multiple species.


The authors recommended that all patients over the age of 50 years who are about to start continuous peritoneal dialysis have a barium enema so that diverticuli could be identified.


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