The Clinical Utility of the Tc-99m SC Intraperitoneal Scan in CAPD Patients

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Abstract
The intraperitoneal instillation of dialysate increases intra-abdominal pressure and consequently predisposes to subcutaneous infiltration, leaks, and herniations through defects in the abdominal wall. In this setting, the incidence of abdominal hernias ranges between 9% and 24%. Life-threatening complications (incarceration/ strangulation) occur in up to 13.2% of hernias. Therefore, the authors evaluated the efficacy of the Tc-99m sulfur colloid (SC) intraperitoneal scan in the detection of abdominal leaks and hernias in 11 continuous ambulatory peritoneal dialysis (CAPD) patients over a 2- year period at the Hospital of the University of Pennsylvania. Eleven patients (7M, 4F) ranging in age from 24 to 72 (mean=50.8), on CAPD, were evaluated for clinically suspected abdominal hernias or dialysate leaks with intraperitoneally administered Tc-99m SC. After the injection of 3-5 mCi of Tc-99m into a standard 2 liter dialysate bag, multiple sequential anterior images of the abdomen were obtained in the supine position over the course of one hour. Delayed images were obtained after ambulation and post-drainage two or more hours postinjection in multiple projections and positions in order to demonstrate any abnormal focal accumulations of fluid to the best advantage. Any detected abnormalities were marked and correlated with the physical examination and the patient's symptoms. Two patients had normal scans. Of the nine abnormal scans, five hernias were identified in four patients and six leaks were detected in the other five patients. One leak and two hernias were confirmed at surgery and repaired. The Tc-99m intraperitoneal scan is a simple noninvasive means of detecting abnormal abdominal fluid collections that have a propensity to develop in CAPD patients and therefore may be an important impact upon patient management.

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