Small Bowel Ileus and Septic Shock in a Patient with Acinetobacter Peritonitis on Continuous Cycling Peritoneal Dialysis

Introduction: Acinetobacter species are aerobic, gram-negative organisms which represent <5% of peritonitis episodes in patients on peritoneal dialysis. We describe the first case to date of Acinetobacter peritonitis complicated by severe ileus and septic shock.Case Description: A 72-year-old African American female with a history of end-stage renal disease on peritoneal dialysis (PD), Type 2 diabetes and hypertension presented to the dialysis clinic with severe, diffuse abdominal pain of one-day duration. The PD fluid was noted to be purulent. The patient received intraperitoneal antibiotics and was sent to the Emergency Department. Laboratory studies revealed a WBC count of 14,000 mm3. Abdominopelvic contrast-enhanced computed tomography (CECT) scan demonstrated no abnormalities. Patient was continued on broad spectrum intraperitoneal antibiotics. The PD catheter became clotted requiring insertion of a temporary hemodialysis line. Peritoneal fluid culture resulted with pan-sensitive Acinetobacter nosocomialis. Ampicillin-sulbactam was initiated but the patient developed abdominal distension. Repeat abdominopelvic CECT scan revealed small bowel ileus. The patient’s course was further complicated by septic shock requiring vasopressors. The PD catheter was removed for source control and a nasogastric tube was placed after which the patient improved. A permanent hemodialysis catheter was placed. The patient was discharged home with ciprofloxacin to complete a two-week course. Conclusion: AP is a rare, yet important, cause of infection in patients on PD that can evolve rapidly and lead to complications. It is paramount to recognize ileus as a potential complication of AP. Early efforts must be made to diagnose AP and manage its complications effectively.