Surgical strategy to save patients with colon perforation with chronic renal failure on long-term hemodialysis

Background/Aims: The aim of the current study is to clarify a strategy to save patients with diffuse peritonitis due to colonic perforation, who have been undergoing long-term hemodialysis with chronic renal failure. Methodology: Five patients with colon perforation with chronic renal failure on long-term hemodialysis were studied and their clinical courses and outcomes after surgical treatment were investigated. Results: The proportion of salvage for patients in our cases was 60%. The chief reasons of failure in salvage in two patients were mainly a delay of surgical treatment and the compromised condition with recurrence of the neoplasm. In the current study, level of serum concentration of C-reactive protein of the patients on admission was found not to be reliable to decide a surgical indication, and delay of the surgical treatment was fatal. Conclusions: The physical examination is most important and reliable to decide the surgical indication for patients with colon perforation, and even with suspicion of peritonitis requiring a laparotomy, an immediate surgical treatment should be courageously performed for patients with chronic renal failure on long-term hemodialysis.