Loculated fluid collections evidenced by peritoneal scintigraphy

A 75-year-old woman treated by hemodialysis for 20 years was switched to peritoneal dialysis (PD) for extensive vascular disease despite having undergone two abdominal surgery procedures. An abdominal computed tomography (CT) scan with contrast did not reveal any adhesion. However, the patient developed progressive ultrafiltration (UF) failure 1 week after starting PD and manifested difficulty in achieving her ideal dry weight despite frequent use of hypertonic solutions. Therefore, we ruled out both abnormalities of peritoneum permeability by evaluating the peritoneal equilibrium test and catheter malposition by abdominal X-ray. Finally, to evaluate the presence of loculated fluid collections due to peritoneal adhesions, we performed a peritoneal scintigraphy with technetium-99m (99m-TC) icodextrin for availability of this compound, routinely used in peritoneal dialysis, for icodextrin persistence in the peritoneal space and because of some limitations of the other 99m-TC-labelled colloids used for peritoneum scintigraphy in recent years. It showed a defective diffusion of the radiocompound during the infusion phase and persistence in the left subdiaphragmatic area and hemiabdomen of 99m-TC-icodextrin after drainage of the dialysate, confirming the diagnosis of UF failure due to loculated fluid collections.