Hemoperitoneum Complicating Videocolonoscopy in a Patient Undergoing Peritoneal Dialysis

Abstract

Hemoperitoneum is a rare complication associated with endoscopic procedures, occurring in approximately 0.22% of cases. Potential causes include infection, mechanical perforation due to excessive air insufflation, therapeutic interventions (such as biopsy and polypectomy), splenic rupture, mesenteric artery dissection, ruptured epiploic appendix, and necrotic intestinal leiomyosarcoma. Major risk factors for this complication are inflammatory bowel disease, therapeutic procedures performed during colonoscopy, and intra-abdominal adhesions from previous abdominal surgeries. The literature contains limited reports of hemoperitoneum in patients undergoing peritoneal dialysis (PD), with a secondary complication being catheter obstruction, which results in the inability to continue dialysis therapy.

Case Presentation: A 50-year-old female patient with end-stage renal disease secondary to thin basement membrane glomerulonephritis has been on peritoneal dialysis (PD) since January 2024. She underwent videocolonoscopy as part of pre-transplant protocol studies. Since the initiation of dialysis, the patient had experienced no complications. During the endoscopic procedure, no significant incidents were reported, and a single polyp was removed. The following day, the patient presented for a follow-up visit asymptomatically, with no signs of fluid overload and blood pressure within her usual range. Abdominal physical examination revealed no pain or signs of peritoneal irritation, with present bowel sounds and positive bowel movement. At the time, she was not receiving anticoagulant or antiplatelet therapy. Peritoneal fluid analysis showed hemoperitoneum with a normal white blood cell count. The findings were attributed to the polypectomy procedure, and it was prescribed to increase the frequency of exchanges using room-temperature fluid. The peritoneal fluid gradually cleared over five days, and the patient recovered without further complications.

Hemoperitoneum is an uncommon but potentially serious complication in patients undergoing peritoneal dialysis and videocolonoscopy. This case emphasizes the need for vigilant clinical monitoring and prompt intervention to manage this condition. Since many cases of hemoperitoneum can be asymptomatic, peritoneal dialysis provides a unique opportunity to detect such occurrences. This prompts further investigation into the frequency of asymptomatic bleeding and whether peritoneal dialysis itself is a contributing risk factor for hemoperitoneum.