Poor flow from Tenckhoff catheter

A 72-year-old patient reported a sudden development of poor outflow from his Tenckhoff catheter; he had been performing continuous ambulatory peritoneal dialysis for 3 years because of diabetic nephropathy and hypertensive nephrosclerosis. There was a slow outflow rate, and the effluent volume was only 400e600 mL after an instillation of 2 L of dialysate; the inflow rate was variable. He reported neither constipation symptoms nor the presence of fibrin in the dialysate effluent. Examination confirmed a right inguinal hernia, which had been known for 6 months, and the patient was scheduled to undergo surgical repair. Drainage volume and flow rate showed no improvement with addition of heparin to the dialysate. Several possibilities of outflow failure (drainage volume being significantly less than the inflow volume) in peritoneal dialysis were considered. Common examples include bowel trapping (mostly due to constipation) and catheter migration (frequently to the subdiaphragmatic location with subsequent omental trapping). In the case of fibrin encasement and catheter kink, the dialysate inflow rate would have been slow as well. Another important