Background: Hemoperitoneum is an infrequent but recognized complication of continuous ambulatory peritoneal dialysis (CAPD), most commonly attributable to abdominal trauma, gynecological causes (follicular cyst rupture, menstrual reflux, ovulation, endometriosis), or intraperitoneal sources such as hepatic or splenic cyst rupture, catheter-related trauma, and vascular anomalies. Hemoperitoneum originating from a retroperitoneal source, particularly cyst rupture in autosomal dominant polycystic kidney disease (ADPKD), is exceedingly rare and has been reported only twice previously in the literature.
Case Presentation: We describe a 45-year-old postmenopausal woman with a 20-year history of ADPKD and ESKD on CAPD, who presented with hemorrhagic peritoneal dialysate outflow followed by complete outflow obstruction, anasarca, and altered sensorium. Imaging demonstrated a large intraperitoneal collection with air foci alongside a separate lesser-sac collection, in the absence of any demonstrable retroperitoneal-to-peritoneal communication or active contrast extravasation. No alternative source of hemorrhage was identified after multidisciplinary evaluation. The patient was managed with temporary discontinuation of CAPD, hemodialysis via a non-tunneled internal jugular catheter, blood transfusion, and intraperitoneal antibiotic therapy, with gradual clinical improvement.
Conclusion: Retroperitoneal hemorrhage should be considered in the differential diagnosis of hemoperitoneum in patients with ADPKD on peritoneal dialysis. Prompt recognition of pain and hemorrhagic dialysate in this population is essential to enable timely intervention and salvage of the peritoneal dialysis modality.
Case Report
Oct 09, 2026
6
4
An Unusual Complication in a Patient on CAPD – Retroperitoneal Hemorrhage: A Case Report
Central Asian Journal of Nephrology, 2(3), 2026, cajn017, https://doi.org/10.63946/cajn/19557
Publication date: Oct 09, 2026
ABSTRACT
KEYWORDS
Hemoperitoneum Peritoneal Dialysis Autosomal Dominant Polycystic Kidney Disease Retroperitoneal Hemorrhage Continuous Ambulatory Peritoneal Dialysis
CITATION (Vancouver)
Saraswathi Y, Yadla M, Kumar V, Pathakala S, Burri S. An Unusual Complication in a Patient on CAPD – Retroperitoneal Hemorrhage: A Case Report. Central Asian Journal of Nephrology. 2026;2(3):cajn017. https://doi.org/10.63946/cajn/19557
APA
Saraswathi, Y., Yadla, M., Kumar, V., Pathakala, S., & Burri, S. (2026). An Unusual Complication in a Patient on CAPD – Retroperitoneal Hemorrhage: A Case Report. Central Asian Journal of Nephrology, 2(3), cajn017. https://doi.org/10.63946/cajn/19557
Harvard
Saraswathi, Y., Yadla, M., Kumar, V., Pathakala, S., and Burri, S. (2026). An Unusual Complication in a Patient on CAPD – Retroperitoneal Hemorrhage: A Case Report. Central Asian Journal of Nephrology, 2(3), cajn017. https://doi.org/10.63946/cajn/19557
AMA
Saraswathi Y, Yadla M, Kumar V, Pathakala S, Burri S. An Unusual Complication in a Patient on CAPD – Retroperitoneal Hemorrhage: A Case Report. Central Asian Journal of Nephrology. 2026;2(3), cajn017. https://doi.org/10.63946/cajn/19557
Chicago
Saraswathi, Yashaswini, Manjusha Yadla, Vikram Kumar, Srinivas Pathakala, and Sreekanth Burri. "An Unusual Complication in a Patient on CAPD – Retroperitoneal Hemorrhage: A Case Report". Central Asian Journal of Nephrology 2026 2 no. 3 (2026): cajn017. https://doi.org/10.63946/cajn/19557
MLA
Saraswathi, Yashaswini et al. "An Unusual Complication in a Patient on CAPD – Retroperitoneal Hemorrhage: A Case Report". Central Asian Journal of Nephrology, vol. 2, no. 3, 2026, cajn017. https://doi.org/10.63946/cajn/19557
REFERENCES
- Wu Z-Z, Yu C-H, Sung J-M. Haemoperitoneum in peritoneal dialysis and polycystic kidney disease: an interesting cause. Perit Dial Int. 2023;43(4):342-4. https://doi.org/10.1177/08968608231169834
- Blake P, Abraham G. Bloody effluent during CAPD in a patient with polycystic kidneys. Perit Dial Int. 1988;8(2):167. https://doi.org/10.1177/089686088800800213
- Biyik Z, Solak Y, Gaipov A, Ozbek O, Esen H, Turk S. Spontaneous retroperitoneal hemorrhage presenting as hemoperitoneum secondary to renal cyst rupture in a peritoneal dialysis patient with acquired cystic kidney disease. Indian J Nephrol. 2015;25(4):251. https://doi.org/10.4103/0971-4065.147371
LICENSE
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.