Abdominal Pain in Peritoneal Dialysis: Peritonitis or Pancreatitis? A Report of Three Cases

Abstract

Pancreatitis in peritoneal dialysis (PD) patients is a complex clinical challenge, often masked by symptoms that overlap with other conditions such as peritonitis. This article presents three clinical cases that illustrate the difficulty of diagnosing and managing pancreatitis in this setting.
The first case concerns a 40-year-old patient who presented with severe acute pancreatitis after two years of PD. The diagnosis, initially mistaken for peritonitis due to the presence of hematic drained dialysat, was rectified by a marked rise in pancreatic enzymes and a CT scan confirming pancreatic necrosis. Despite rapid treatment, including CT-guided drainage, the patient died of septic shock.
The second case involved a 64-year-old patient with chronic pancreatitis predisposed by familial hypertriglyceridemia. Although this patient survived several episodes of pancreatitis, the management of her condition required constant monitoring and ongoing adjustment of her PD therapy.
The third case describes a 58-year-old patient whose acute lithiasis-induced pancreatitis rapidly progressed to pancreatic necrosis, leading to fatal septic shock, despite CT-guided drainage.
These cases highlight the importance of increased vigilance in monitoring patients with PD, in whom pancreatitis can develop insidiously. Diagnosis must be based on rigorous clinical assessment, relevant biological markers such as lipase, and appropriate imaging to avoid potentially fatal delays in treatment. Early multidisciplinary management is essential to improve the prognosis of this serious complication, which is often underestimated in the peritoneal dialysis population.