Acute abdomen in the hemodialysis patient population

Background. The cause and frequency of the acute abdomen in patients undergoing hemodialysis are not well reported. Previous studies associate bowel infarction with hemodialysis, but dialysis generally is not implicated as a risk factor for mesenteric ischemia. Methods. The records of 567 patients undergoing long-term hemodialysis during the period from July 1988 to June 1993 were retrospectively reviewed. Results. Twelve patients (2.1% of the hemodialysis population) were admitted with acute abdominal pain or sepsis. They were demographically no different than their counterparts who did not have an acute abdomen. The final diagnoses were bowel infarction in 11 patients and acute pancreatitis in one. Principal areas of involvement were equally divided between large and small intestine and were due to nonocclusive mesenteric ischemia in all cases. Six patients had an occluded hemodialysis fistula on admission, suggesting hypotension and/or hypovolemia as a possible etiologic factor. Overall, mortality and major morbidity rates were 50% and 25%, respectively. Conclusions. An acute abdomen is a relatively uncommon problem in the hemodialysis population but is associated with a high mortality. Mesenteric infarction is the most common cause and should be the presumptive diagnosis until proven otherwise.