Rare case of small-bowel foreign body in peritoneal dialysis (with video)

A 61-year-old man had received peritoneal dialysis for uremia since June 2016, and because of recurrent anemia he underwent EGD and colonoscopy survey. Eradication of Helicobacter pylori, administration of protein pump inhibitors for peptic ulcer, and colonoscopic polypectomy for colon polyps were performed; however, low hemoglobin level of 5.8 g/dL and 2 episodes of dialysate peritonitis with Escherichia coli were noted within half a year. Therefore, he underwent capsule endoscopy to survey for occult GI bleeding. Capsule endoscopy showed a foreign body embedded in the proximal part of the ileum (small-bowel time 64%) (A) and oral-sided double-balloon enteroscopy was arranged for foreign body removal. Before the procedure, prophylactic antibiotic with ampicillin/sulbactam was prescribed. As enteroscopy deepened to the proximal art of the ileum (approximately 310 cm after the pylorus), a fish-bone-like foreign body was observed. After being localized with India-ink tattooing, the foreign body was removed by forceps, and the defect was closed with a endoscopic clip (B) (Video 1, available at www.giejournal.org) Although the patient did not experience obvious abdominal pain on the next day, turbid dialysate and analysis of the dialysate revealed a cell count of ≤1190/mm³. Therefore, under the impression of dialysate peritonitis, antibiotics were administered for 5 days. During the later years of follow-up, the episodes of dialysate peritonitis declined, and the patient’s hemoglobin level achieved stability.