Semi-Urgent Totally Extraperitoneal Repair for Inguinal Hernia Causing Insufficient Intraperitoneal Exchange in a Patient on Peritoneal Dialysis: A Case Report.

Abstract

<h4>Introduction</h4>Inguinal hernias are mechanical complications in patients undergoing peritoneal dialysis (PD) that may threaten the continuation of PD. Herein, we report a rare case in which PD could not be completed owing to outflow failure associated with a large inguinal hernia that was successfully managed with semi-urgent totally extraperitoneal (TEP) repair.<h4>Case presentation</h4>A 79-year-old man with a known inguinal hernia was diagnosed with chronic kidney disease. On day 8 after PD initiation, the inguinoscrotal swelling worsened, and the dialysate could not be adequately recovered, making continuation of PD challenging. CT revealed a small bowel within the hernia sac with subcutaneous edema and hydrocele, although the PD catheter tip remained in an appropriate intraperitoneal position without migration to the hernia sac. Because urgent restoration of PD was required, a semi-urgent TEP repair was performed, avoiding peritoneal incision to facilitate early PD resumption. PD was restarted on POD 1 with total dialysate volume of 2000 mL/day, which increased to 4000 mL/day on POD 2, and returned to the usual volume of 6000 mL/day by POD 6. No recurrence was observed at 6 months.<h4>Conclusions</h4>Large inguinal hernia can cause severe PD outflow failure even without catheter migration. Semi-urgent TEP repair may allow early resumption of PD and help preserve this modality in selected patients.