Perforation of small intestine diverticulum in a maintenance hemodialysis patient

We report perforation of a small intestine diverticulum in a maintenance hemodialysis patient. The patient was a 57-year-old male. He was undergoing continuous ambulatory peritoneal dialysis (CAPD) for chronic glomerulonephritis (CGN) since 1984. In 1992, his dialysis therapy was changed from CAPD to hemodialysis (HD) because of peritonitis. On September 29, 2007, he developed abdominal pain, and on October 2, 2007, he complained of more severe pain and muscular tenderness and was positive for Blumberg's sign. He was admitted in emergency. Abdominal CT scan revealed some free air in the endoperitoneum. Emergency laparotomy was performed following the diagnosis of panperitonitis due to intestinal perforation. We found a perforation measuring 1 mm in diameter at the actinal side approximately 10 cm from the Bauhin valve, however, no other abnormalities were detected in the abdominal cavity. Partial bowel resection was performed, and a segment approximately 50 cm in length, including the perforated lesion, was excised. The postoperative course was uneventful, and he was discharged on October 17, 2007. Pathological findings of the resected specimen revealed a perforation of diverticulum with inflammatory changes. Such perforation of small intestine diverticulum in a hemodialysis patient has rarely been reported in the literature, and we emphasize that prompt laparotomy is necessary for the prevention of severe complications.