Application of peritoneal dialysis in a patient with lumbar spina bifida and congenital malformations of the urinary tract as the ultimate method of treatment in the absence of vascular access to extracorporeal techniques

Abstract

We have described a case of a 29-year-old female patient with chronic renal disease as a complica­tion of congenital defects in the form of lumbar spina bifida with neurogenic bladder, treated with hemodialysis since 2008. In January 2017 she was admitted to the nephrological ward due to fail­ure of arteriovenous fistula on the right arm asso­ciated with infection and progressive thrombosis, despite of outpatient implementation of treatment with antibiotic and low molecular weight heparin. Finally, there was a complete occlusion of the ar­teriovenous fistula with the occurrence of a septic condition. In a vascular scan, a number of patholo­gies in the venous vessels of the upper extremities and the thorax have been reported in the form of stenosis and multi-location thrombosis. Temporar­ily dual-channel vascular catheter for hemodialysis was fixed to the very narrow right femoral vein, the only vessel available for cannulation and the patient has been qualified for treatment with peritoneal di­alysis. Tenckhoff catheter was implanted surgically with significant complications during the proce­dure. At the opening of the peritoneal cavity came to infringement (opening) of the bladder which after augmentation surgery is higher and fused with the front wall of the abdomen including the peritoneum. The bladder was partially dissected from the ab­dominal wall and the Tenckhoff catheter was im­planted bypassing the bladder and guiding its tip to the right hip bottom. In March 2017, automatic peritoneal dialysis treatment was started. Volume of a single replacement is 850 mL. Currently, renal replacement therapy is without complications, the patient is clinically and laboratory aligned, and fully accepts the treatment method.