A case of recurrent bloody dialysate at midcycle of menstruation in a woman receiving continuous ambulatory peritoneal dialysis (CAPD)

• Published in: Journal of Japanese Society for Dialysis Therapy Vol. 25; no. 12; pp. 1377 - 1381
• Main Authors: Sakurai, Yusei, Kawabe, Mitsuhiko, Takeuchi, Masashi, Hayama, Naoaki, Sakamoto, Hisaoto, Kuwahara, Michio, Yoneshima, Hideo, Akiba, Takashi, Kubota, Toshiro, Kurihara, Satoshi
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society for Dialysis Therapy 1992
• Subjects: bloody dialysate; CAPD; midcycle bleeding; ovarian chocolate cyst
• ISSN: 0911-5889; 1884-6211
• DOI: 10.4009/jsdt1985.25.1377

Bloody dialysate just before or during menstruation in women maintained on CAPD treatment is a well-described occurrence. However, it is infrequent for bloody dialysate to occur at the midcycle of menstruation. We report a case of a woman who has experienced recurrent bloody dialysate at midcycle of menstruation. A 34-year-old woman with end-stage renal disease secondary to diabetic nephropathy was started on continuous ambulatory peritoneal dialysis (CAPD). After 3 months of CAPD, she experienced recurrent bloody dialysate effluent with lower abdominal pain at the midcycle of menstruation. The bloody dialysate during these episodes contained no polymorphonuclear neutrophils or bacterial organisms. She was found to have a left ovarian chocolate cyst by CT and MRI examination. Since this suggested the bleeding was originating from the left ovarian cyst, she was started on treatment with a gonadotropin releasing hormone (GnRH) agonist (buserelin). After 6 months of intranasal buserelin administration at 600-1, 200μg/day, bloody dialysate and lower abdominal pain completely disappeared. On MRI examination, the size of the chocolate cyst had decreased markedly after 6 months of treatment. We speculate that the bloody dialysate in this woman may have been triggered by ovulation, and several mechanisms may have been responsible: 1) direct bleeding from the chocolate cyst, 2) bleeding from a fragile ovarian capsule and/or 3) bleeding from endometrial tissue around the ovary. When bloody dialysate at the midcycle of menstruation is found in women on CAPD treatment, detailed investigations should be performed, including ultrasound echography, CT scanning and/or MRI.