A case of severe bleeding and deep inferior epigastric pseudoaneurysm after peritoneal dialysis catheter removal

Abstract

We present an unusual but severe complication of peritoneal dialysis (PD) catheter removal resulting in significant haemorrhage and hospitalisation. A patient presented for PD catheter removal under local anaesthesia in the interventional radiology suite and was noted to have a heavily calcified deep Dacron cuff. This cuff was intimately associated with a deep inferior epigastric perforating (DIEP) vessel. Removal of the catheter resulted in shearing of DIEP vessel and pseudoaneurysm formation. Despite attempted surgical management with ligation haemorrhage continued, requiring urgent angiographic embolisation to stop the bleeding. Intimate relationship between DIEP vessel and Dacron cuff due to calcification was the cause of this complication. This case report represents a rare but important complication associated with PD catheter removal, highlighting that when calcification is seen at the deep cuff, caution should be exercised and there should be access to angiography suite in case of complication.