APPENDICITIS PERFORATA IN CAPD PATIENTS- REPORT OF TWO CASES

Two patients on CAPD had peritonitis due to perforated appendicitis. Both presented with diffuse painful peritonitis with nausea, fever and prostration. There was blood leukocytosis with a shift to the left. The peritonitis did not respond to anti-biotic therapy. The diagnosis was made after 8 and 18 days respectively by exploratory laparotomy. Both patients had a gangrenous perforated appendix surrounded by abscess. Both patients had uncomplicated recovery after appendectomy, drainage, removal of the Tenckhoff catheter with discontinuation of CAPD and change to hemodialysis. Our experience suggests that a perforated appendix might be recognized early in a patient with apparent fecal peritonitis in whom other more common causes (e.g. diverticulosis / diverticulitis) have been ruled out, or when he presents with severe symptoms and a low peritoneal white cell count