Review for 10.1186/s12876-020-01303-1 (2020)

Reviewer ’s report  
 
Title : Intestinal fistula accompanied by recurrent peritonitis associa ted with peritoneal dial ysis: a 
case report  
 
Version: 0 Date: 02 Feb 2020  
 
Reviewer: Joyita Bharati  
 
Reviewer's report:  
 
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This case reports highlights an important information on rare complications of peri toneal dialysis 
(PD) and a successful conservative management of the same. Despite the patient having acute 
peritonitis with intestinal fistula, catheter removal (without surgical repair) was successful in the 
management, which is interesting. Following ar e few comments and queries on this manuscript.  
 
No.1: Line #23 states that "some complications are common such as peritonitis, pain and 
feculent dialysate effluent with watery diarrhoea" with a reference [1]. This statement is not 
entirely correct as fecule nt dialysate effluent is a rare complication of PD related to bowel 
perforation by the catheter. The reference [Wang R, Chen Z, Wang J, Zhang X, Shou Z, Chen J. 
Delayed bowel perforation in a peritoneal dialysis patient: a case report and literature review . 
Perit Dial Int. 2014;34:460 -6] does not state this either.  
 
No.2: Line #31 -32 state that "leakage of peritoneal dialysis fluid was noted at the orifice of the 
peritoneal dialysis tube". Further evaluation of this finding was not mentioned in the followin g 
section.  
 
No.3: Lines #62 -64 state that "Perforation may also occur in association with chronic peritoneal 
dialysis, with its repeated episodes of peritonitis.." Repeated peritonitis is typically a 
manifestation rather than cause of intestinal perforation/fistula fo llowing PD catheter insertion. 
So, the assumption that repeated peritonitis caused intestinal perforation/fistula in this patient 
may not be correct. Peritoneal adhesion (between intestine and abdominal wall) following 
peritonitis may predispose for bowel wall perforation. The presence of extensive peritoneal 
calcification (as described in this patient) could be attributed to cause intestinal 
perforation/fistula in the index case. A search or note on colonic diverticulitis in this patient 
(which is a known risk factor to cause intestinal perforation/fistula) would be worthwhile. 
Moreover, previous history of intermittent cessation of PD due to repeated peritonitis, if present 
in this patient, could have caused this complication as an immobile catheter withou t fluid in the 
abdomen predisposes to this complication. Presence of dialysate leak around the orifice of PD 
catheter could imply increase in abdominal pressure. Increased abdominal pressure, in turn, is 
associated with intestinal perforation, as seen in p atients with polycystic kidney disease.  
 
No. 4: Figures should preferably have arrows/arrowheads to mark the findings  
 
Are the methods appropriate and well described?  
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Yes 
 
Does the work include the necessary controls?  
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No 
 
Are the conclusions drawn adequately supported by the data shown?  
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Unable to assess  
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
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Needs some language corrections before being published  
 
Declaration of competing interests  
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