Nephron 32 : 281-282 (1982)

Acute Abdomen in Chronic Renal Failure

A. Martinez-Vea, J. Montoliu, C. Monroy, M.Lanuza, J.Lopez Pedret, L. Revert

Nephrology Service, Hospital Clínico y Provincial, University of Barcelona, Spain

Sir, Table I. Causes of acute abdomen in uremic patients and in the

Patients with chronic renal failure seem prone to general population
develop acute abdominal emergencies due to causes dif­ General Uremic P
ferent from those usually found in the general population. population patients
Spontaneous perforation of the colon [1], ischemic necro­ n % n %
sis of the small bowel with cystic neumatosis [2], diverticu­
litis [3], pancreatitis [4], spontaneous peritonitis [5] and Localized inflammation 134 54.9 9 47.3
ischemic colitis following bilateral nephrectomy [6] have Appendicitis no 7 NS
all been described in chronic renal failure. We also read Cholecystitis 24 1
Diverticulitis - 1
with interest the recent report by Aubia et al. [7] on the Intestinal obstruction 49 20 -
occurrence of ischemic colitis in 3 patients with terminal Hernia 27
uremia due to polycystic kidney disease. However, and in Adhesions 12
spite of all of these isolated reports, the real incidence of Cancer of the colon 6
the different causes of acute abdomen in patients with Volvulus of the colon 4
Visceral perforation 30 12.2 -
irreversible uremia is largely unknown. Peptic ulcer 22
We have reviewed our experience with 19 cases of acute Cancer of the colon 4
abdomen among patients with terminal uremia and we Small bowel 2
have compared them with a group of 244 patients with Urine bladder 1
Colonic diverticulum 1
normal renal function and acute abdominal pain who were
Hemoperitoneum 8 3.2 5 26.3 <0.001
seen consecutively over an 8-month period at our hospi­ Pancreatitis 8 3.2 5 26.3 < 0.001
tal’s emergency room. Mean age in both groups was Pelvic peritonitis of
similar (39.4 ± 14 and 45.9 ±23.7 years, respectively). gynecologic origin 5 2 _
Of the 19 patients with renal failure, 17 were on hemo­ Mesenteric thrombosis 3 1.2 -

dialysis, which means a 7.5% incidence of acute abdomen
in our hemodialysis population (226 patients during an
average time on dialysis of 46.9 ±35.9 months). The 2
patients with renal failure who were not on dialysis had
serum creatinines of 530 and 512 p.mol/1, respectively.
The more frequent causes of acute abdomen in uremic
patients were local inflammation (mainly appendicitis),
pancreatitis and hemoperitoneum, whereas in the group
with normal renal function they were local inflammation
(appendicitis), intestinal obstruction and visceral perfora­
tion (table I). Acute pancreatitis and hemoperitoneum
were significantly more frequent in uremic patients than in
the control population (table I). In patients with chronic
Miscellaneous 7 2.8 -
renal failure, hemoperitoneum was caused in 1 patient
each by ruptured ovarian cyst, ectopic pregnancy, gan­
grenous cholecystitis with perforation of the gallblader,
hemorrhage following liver biopsy, and splenic rupture.
There was no relationship between the etiology of renal
disease and the cause of acute abdomen. In 40% of cases,
abdominal pain started during hemodialysis, particularly
in cases of pancreatitis and hemoperitoneum. Preoperative
diagnosis was correct in 70% of all cases. Mortality was
11 % (2 cases of pancreatitis).
282
Thus, although relatively unusual diseases presenting
with abdominal pain can develop in patients with terminal
uremia, acute appendicitis is still the commonest cause of
acute abdomen in this group, whereas acute pancreatitis
and hemoperitoneum occur with more frequency than in
the general population. In contrast with the report of
A ubia et al., ischemic colitis was never found in our
patients with renal failure.
References
1 Lipschutz, D .E .; Sterling, R.E.: Spontaneous perforation of the
colon in chronic renal failure. Archs intern. Med. 132: 758-759
(1973).
2 Clinicopathologic Conference: Gastrointestinal symptoms and
shock in a patient with chronic renal failure. Am. J. Med. 69:
595-602 (1980).
Martinez-Vea/Montoliu/Monroy/Lanuza/Lopez Pedret/Revert
3 Schcff, R.T.; Zuckerman, G.; Harter, H.; Delmez, J.; Koehler,
R .: Diverticular disease in patients with chronic renal failure due
to polycystic kidney disease. Am. J. Med. 92: 202-204 (1980).
4 Engel, J.J.; Bischcl, M. D.: Acute pancreatitis abd kidney disease.
Dial. Transplant. 10: 817-822 (1981).
5 Warner, E.; Lustig, S.; Boner, G.; Roscnfcld, J.B.: Fulminant
spontaneous acute bacterial peritonitis in maintenance hemo­
dialysis. Clin. Nephrol. 16: 107-108 (1981).
6 Margolis, D. M.; Ethercdge, E.E.; Garza-Garza, R.; Hruska, K.;
Anderson, C. B.: Ischemic bowel disease following bilateral
nephrectomy or renal transplant. Surgery 82: 667-673 (1977).
7 Aubia, J.; Lloverás, J.; Munnc, A.; Solsona, J.; Masramón, J.;
Orfila, M .A.; Riambau, E.; Serrano, S.; Llorach, M.: Ischemic
colitis in chronic uremia. Nephron 29: 146-150 (1981).
A.Martincz-Vea, Nephrology Service, Hospital Clinico y
Provincial, University of Barcelona, Barcelona (Spain)