Fig. 2

Schematic overview of non-infectious PD complications. In relation to malposition, a laxative is considered first to smoothen the intestinal movement, and the manipulation of the catheter using a semi-flexible wire or surgical repositioning is the next strategy. In case of kinks, a wire technique to straighten the kinking site or surgical replacement is utilized. Surgical replacement is adapted for an intraluminal-occluded catheter in cases of ineffective drug infusion or for a catheter wrapped by external tissues which cannot be removed. In case of external oppression by the bowel tract, laxatives are suitable; however, when external oppression is induced by a firmly adhesive intestine, surgical adhesiolysis should be considered. Leakage could be conservatively improved by the reduction or discontinuation of dialysate exchange or by changing the patient’s position during dialysate dwell time. Surgery should be considered if catheter-related leakage is prolonged or repetitive. Hydrothorax induced by IAP elevation requires pleurodesis or surgical repair using VATS in the absence of improvement by conservative measures. Although hernia is often restored spontaneously by decreasing IAP via the reduction or discontinuation of PD, surgical repair is required if there is a recurrence or if the herniated intestine is incarcerated. In metabolic disorders mainly induced by a high glucose-containing dialysate, we consider the use of medications and changing the PD regimen with a glucose-sparing dialysate. To avoid EPS progression, infection control and a biocompatible or glucose-sparing dialysate should be considered. In the inflammatory phase, steroid or tamoxifen administration may be considered, and if ileus is present, adhesiolysis should be chosen. EPS, encapsulating peritoneal sclerosis; IAP, intraperitoneal pressure; PD, peritoneal dialysis; S/P, spine position; t-PA, tissue plasminogen activator; VATS, video-assisted thoracoscopy