Nocturnal Left Upper Abdominal Pain After Peritoneal Dialysis

Persistent left upper abdominal pain for one and a half months?

Hello Doctor, my father has been on automated peritoneal dialysis (APD) for over two years.
After experiencing a dislodged peritoneal dialysis catheter last September, he underwent laparoscopic surgery for fixation.
Although there was a leakage incident, he has since recovered well, and his dialysis is proceeding smoothly without complications such as peritonitis.
However, it is strange that for the past month, he has been experiencing left upper abdominal pain around 11 PM every night.
Initially, we thought it was a recurrence of a gastric ulcer, and after taking Tegoprazan, the pain that used to occur around 7 PM has now shifted to around 11 PM.
The pain worsens when lying down (regardless of whether he is lying flat, on his side, or curled up), and only eases when sitting or standing, turning into a dull ache.
The pain then persists throughout the night.
Interestingly, he experiences no discomfort during the day, even while undergoing peritoneal dialysis, regardless of his position (lying, sitting, or standing), and he does not have the same pain at night.
Because he feels completely fine during the day, he is unable to describe the location and nature of the pain during daytime consultations.
This issue has caused both my father and mother to suffer from insomnia for a long time, and it has become increasingly concerning.
Could you please provide some advice and direction? Thank you.

Dora Chen, 30~39 year old female. Ask Date: 2016/10/26

Dr. Chen Jiaming reply Surgery

Based on your description, there are too many potential influencing factors.
Pain at a specific point in time may sometimes relate to the recent medication status, such as whether pain relief medications have been used.
For gastrointestinal and hepatobiliary issues, endoscopy and abdominal ultrasound are needed for further evaluation.
The presence of a peritoneal dialysis catheter and the subsequent laparoscopic surgery for repositioning may affect the structures and nerve distributions in the abdominal wall.
The daily dialysis schedule can also impact issues such as abdominal distension and contraction, the angles of the tubing, and potential pathways of compression.
You may want to discuss this in detail with the physician who placed the dialysis catheter.

Reply Date: 2016/10/26

More Info

Understanding nocturnal left upper abdominal pain after peritoneal dialysis (PD) can be quite complex, especially considering the unique circumstances surrounding your father's medical history and current treatment. Given that he has been undergoing automated peritoneal dialysis (APD) for over two years and recently underwent laparoscopic surgery to secure the PD catheter, it is essential to consider several factors that could contribute to his symptoms.

Firstly, the timing of the pain—occurring consistently around 11 PM—suggests a possible correlation with the dialysis process itself. During APD, fluid is infused into the peritoneal cavity, which can lead to distension and discomfort. If the fluid volume or the timing of the exchanges is not optimal, it could potentially cause discomfort that manifests as pain, particularly when lying down. The fact that the pain worsens with lying down and improves when sitting or standing may indicate that the position is influencing the pressure within the abdomen, exacerbating the discomfort.

Additionally, the nature of the pain being described as a dull ache that persists throughout the night could suggest that it is related to the peritoneal lining or the abdominal wall. After surgery, the anatomical changes and potential nerve irritation or scarring could lead to altered sensations or pain responses. The abdominal wall's structure and the nerves in that area may have been affected by the surgery, leading to localized pain that is more pronounced at night when the body is at rest.

Another consideration is the possibility of gastrointestinal issues. The transition from experiencing pain earlier in the evening to a more fixed time later could indicate a change in digestive patterns or the effects of medications, such as the use of antacids like Tums (calcium carbonate). If the pain is related to gastric issues, it may be worthwhile to explore dietary factors or the timing of meals in relation to dialysis sessions.

It is also important to rule out any complications related to the PD catheter itself, such as infection or catheter malfunction, even if there have been no reported infections. Regular monitoring and communication with the healthcare team are crucial in this regard. If the pain persists or worsens, further imaging studies, such as an abdominal ultrasound or CT scan, may be warranted to assess for any underlying issues that could be contributing to the pain.

Given that your father experiences no discomfort during the day, it may be beneficial to keep a detailed pain diary. This diary should include the timing of the pain, its intensity, any associated symptoms (like nausea or changes in bowel habits), and the positions that alleviate or exacerbate the pain. This information can be invaluable for the healthcare provider in diagnosing the issue.

In conclusion, the nocturnal left upper abdominal pain your father is experiencing after peritoneal dialysis could be multifactorial, involving aspects of the dialysis process, postoperative changes, and potential gastrointestinal issues. It is essential to maintain open communication with his healthcare team, consider adjustments to his dialysis regimen, and possibly explore further diagnostic evaluations to ensure that any underlying issues are addressed.

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