Peritoneal Dialysis Catheter Migration with Bowel Erosion and Anal Extrusion in a Neonate: A Case Report
Patil Jyothi 1*, Reshma Kolluru 1
*Correspondence to: Patil Jyothi, Consultant Paediatrician, Dept of Paediatrics, Femcity Women and Children Hospital, Hyderabad.
Copyright
© 2026: Patil Jyothi. 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.
Received: 03 June 2026
Published: 01 July 2026
DOI: https://doi.org/10.5281/zenodo.21093109
Abstract
Aim: Peritoneal dialysis (PD) is widely used in neonates for the management of acute kidney injury (AKI), severe electrolyte disturbances, and hypernatremic dehydration. Although generally considered safe and effective, PD is associated with several complications, including catheter malfunction, infection, and catheter migration. Bowel erosion and trans-anal extrusion of a PD catheter are exceptionally rare complications, particularly in neonates. We report a case of a 15-day-old neonate who developed migration of a PD catheter into the intestine with anal extrusion shortly after catheter insertion. The patient was successfully managed conservatively with catheter removal, antibiotic therapy, reinsertion of a new PD catheter, and close clinical monitoring without the need for surgical bowel repair. This case highlights the potential for conservative management in carefully selected patients without evidence of peritonitis or hemodynamic instability.
Keywords: Peritoneal dialysis, catheter migration, bowel erosion, anal extrusion, neonate, conservative management.
Introduction
Peritoneal dialysis (PD) is considered the preferred modality of renal replacement therapy in neonates with acute kidney injury (AKI), severe electrolyte abnormalities, hypernatremic dehydration, and certain congenital anomalies, owing to its technical simplicity and feasibility in this age group. (1,2) Compared with hemodialysis, PD requires minimal equipment and can be performed without highly specialized personnel, making it particularly valuable in neonatal intensive care settings. (3)
Despite its advantages and high success rates, PD is associated with several complications. Catheter migration is a recognized complication and occurs more commonly in neonates because of factors such as low birth weight, weak abdominal musculature, and a relatively small peritoneal cavity. Erosion of a PD catheter into the bowel is an extremely rare but potentially serious complication that may lead to intestinal perforation, peritonitis, and sepsis.
We present a rare case of PD catheter migration with bowel erosion and trans-anal extrusion in a neonate, which was successfully managed conservatively without definitive surgical repair of the bowel.
Case Report
A 15-day-old late preterm male neonate with birth weight of 1.700 kgs, with admission weight of 1.550 kgs was admitted with a history of loose stools and vomiting following formula feeding for two days with fever, decreased activity, and reduced urine output for one day before presentation.
On admission, the baby exhibited poor respiratory effort and was intubated for ventilatory support. Arterial blood gas analysis revealed severe metabolic acidosis. Sepsis markers were positive, and renal function test indicative of acute kidney injury with oliguria. Despite fluid resuscitation, repeat renal function tests showed worsening biochemical parameters.
In view of persistent oliguria and deteriorating renal function, peritoneal dialysis was initiated. A PD catheter was inserted below the umbilicus under strict aseptic precautions.
Approximately sixteen hours after catheter placement, the catheter was noted to have migrated into the bowel, with its distal tip protruding through the anal opening. The catheter was promptly removed. No feculent discharge or stool was observed within the catheter lumen or at its tip. Examination of the catheter insertion site revealed no evidence of peritoneal or pelvic contamination. There were no clinical or operative findings suggestive of bowel perforation, and therefore no bowel exploration or definitive intestinal repair was performed.
Because of persistent oliguria and worsening renal parameters, a new PD catheter was inserted, and peritoneal dialysis was resumed. The patient was closely monitored with serial clinical examinations and imaging as indicated. No evidence of pneumoperitoneum, peritonitis, bowel perforation, or other complications was observed during follow-up.
Peritoneal dialysis was continued successfully for five days. The neonate showed gradual clinical and biochemical improvement and was discharged after 14 days of hospitalization.
Discussion
Migration of a peritoneal dialysis catheter into the intestine due to bowel erosion is an uncommon complication, particularly in neonates. Most reported cases in the literature involve adult patients, many of whom undergo surgical exploration and repair of the affected bowel segment.
The pathogenesis of bowel erosion is thought to involve prolonged direct contact between the catheter and bowel wall, leading to pressure necrosis, gradual erosion, and eventual perforation. Factors such as inadequate catheter positioning, lack of intraperitoneal fluid, and prolonged catheter inactivity may contribute to this process. (4,5)
Several preventive strategies have been proposed, including appropriate catheter placement, regular catheter flushing, continuous peritoneal lavage when indicated, and the use of intraperitoneal antibiotics in selected cases. These measures may reduce direct friction between the catheter and visceral organs and thereby decrease the risk of pressure-induced bowel injury.
Despite careful insertion techniques, visceral injuries involving the bowel, bladder, and even the uterus have been reported. (6,7) In addition, PD catheter insertion practices vary significantly among institutions, and insertion-related injuries remain well documented. (8,9)
Interestingly, trans-anal extrusion has been more frequently described with ventriculoperitoneal shunt catheters in pediatric patients. (10,11,12) Although PD catheters are larger in diameter and theoretically capable of causing more significant bowel injury, many catheter-related bowel perforations may remain localized and self-limiting.
Our patient remained hemodynamically stable and exhibited no signs of peritonitis, abdominal contamination, or pneumoperitoneum. Under these circumstances, conservative management with catheter removal, antibiotic therapy, reinsertion of a new PD catheter, and vigilant monitoring proved successful. This case supports the growing evidence that selected patients without clinical deterioration may be managed non-operatively.
Management Considerations
Management of PD catheter migration with bowel erosion should be individualized based on the patient's clinical condition.
Conservative management may be considered when:
Conservative treatment includes:
Surgical exploration and definitive bowel repair should be considered in patients who develop:
Conclusion
Peritoneal dialysis catheter migration into the bowel with trans-anal extrusion is an exceptionally rare complication in neonates. Although surgical intervention has traditionally been considered the standard approach, conservative management may be successful in carefully selected patients who show no evidence of peritonitis, bowel contamination, or hemodynamic compromise. Prompt catheter removal, appropriate antibiotic therapy, and close monitoring are essential. Surgical exploration and bowel repair should be reserved for patients who demonstrate clinical deterioration or complications suggestive of ongoing bowel injury.
Disclosures
The authors declare no financial conflicts of interest.
References