Scintigraphic detection of abdominal hernias associated with continuous ambulatory peritoneal dialysis

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Abstract
Continuous ambulatory peritoneal dialysis (CAPD) is an increasingly popular method of renal replacement therapy. There are many recognized abdominal complications including the leakage of dialysate fluid into abnormal sites (Steiner & Halasz, 1990). This may occur internally into the hernial sacs, the abdominal wall or the pleural cavity, or externally around the Tenckhoff cannula, or even via the female genital tract (Khanna et al, 1981). Whenever possible, pre-existing hernias are repaired before commencing CAPD, as the raised intraperitoneal pressures involved can precipitate incarceration (Rubin et al, 1982). In addition, approximately 18% of patients will develop hernias during treatment (Johnson et al, 1987). Indirect inguinal, incisional, umbilical, ventral and diaphragmatic hernias are all described (Francis et al, 1984). A common clinical problem is that of patients presenting with generalized swelling of the anterior abdominal wall, scrotum or labia. Localization of the abnormal communication is often not possible clinically. This report concerns nine patients presenting over a 3 year period in whom peritoneal scintigraphy was employed to detect the site of the leak. Nine patients on CAPD were referred for scintigraphic evaluation after developing soft tissue swelling of the anterior abdominal wall, scrotum or labia. No patient was known to have a pre-existing hernia and no hernias were apparent on clinical examination. A total of 10 examinations were performed. A dose of 70 MBq of 99Tcm-DTPA was injected into a 1 dm3 bag of dialysate. This was run into the peritoneal cavity over 10 15 min via the indwelling Tenckhoff cannula.