Blunt abdominal trauma: a hidden culprit
Abstract
NDT Plus (2009) 2: 171â172 doi: 10.1093/ndtplus/sfn198 Advance Access publication 22 December 2008 Nephroquiz (Section Editor: M. G. Zeier) Wei-Liang Chen1 and Yu-Tzu Tsao2 Department of Emergency Medicine and 2 Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan Keywords: continuous ambulatory peritoneal dialysis; chylous ascites; dihydropyridine calcium channel blocker; pneumoperitoneum Case A 36-year-old uraemic woman presenting with blunt abdominal trauma after a motor vehicle collision was referred to the emergency department. She had been undergoing continuous ambulatory peritoneal dialysis (CAPD) for 1 week due to end-stage renal disease. On physical examination, she was normotensive, and the only abnormal physical findings were periumbilical tenderness without rebounding pain. Laboratory studies showed haemoglobin 10.8 g/dL, leukocyte count 8.34 à 103 /μL, and normal liver function. Notably, plain film radiography of the chest demonstrated massive intraperitoneal free air (Figure 1). Besides, the 2L exchange bag of dialysate solution showed markedly cloudy peritoneal effluent (Figure 2). A serum-to-ascites albumin gradient was 0.8 g/dL and analyses of the turbid peritoneal effluent only yielded high triglyceride concentration (287 mg/dL, compared with serum level 98 mg/dL) without evidence of microorganism or cellular components (Figure 3). Question What is your