Intestinal Prolapse and Exposure After Peritoneal Dialysis in Low-birth-weight Preterm Infants with Acute Renal Failure: a Case Report

Background: The mortality rate of acute kidney injury (AKI) in low-birth-weight premature infants with acute renal failure is extremely high. Since small hemodialysis catheters do not exist, peritoneal dialysis (PD) is the most suitable dialysis method. At present, only a few studies have reported cases of PD in low-birth-weight newborns.

Case Description: On September 8, 2021, a 10-day-old, low-birth-weight preterm infant, who presented with neonatal respiratory distress syndrome and acute renal failure, was admitted to the Second Affiliated Hospital of Kunming Medical University, China. The patient was the elder of twins and had experienced acute renal failure, hyperkalemia, and anuria following the onset of respiratory distress syndrome. During the initial PD catheterization operation, a double Tenckhoff adult PD catheter cut short by 2 cm was used, with the inner cuff placed in the skin. However, the surgical incision was relatively large, and PD fluid leakage occurred. Later, the incision tore, and the intestines prolapsed when the patient cried. The intestines were returned to the abdominal cavity in an emergency operation, and the PD catheter was placed again. This time, the inner Tenckhoff cuff was placed outside the skin, and PD fluid leakage did not reoccur. However, the patient also experienced a decrease in heart rate and blood pressure, as well as severe pneumonia and peritonitis. Following an active rescue, the patient recovered well.

Conclusions: The PD method effectively treats low-birth-weight preterm neonates with AKI. An adult Tenckhoff catheter was shortened by 2 cm and successfully used in the PD treatment of a low-birth-weight preterm infant. However, the catheter placement should be outside the skin, and the incision should be as small as possible to avoid leakage and incision tears.