Intraperitoneal Rupture of Infected Cyst in a Patient with Polycystic Kidney Disease after Kidney Transplant: A Case Report

Autosomal dominant polycystic kidney disease (ADPKD) is a multisystem disorder characterized by progressive renal cysts formation and extra-renal manifestations. Infection within the cysts and abscess formation are rare but life threatening if left untreated. We present a rare case of peritonitis presentation due to intraperitoneal rupture of an infected cyst in a woman with polycystic kidney disease.

 A 42-year-old woman presented with constant progressing abdominal pain and vomiting. She complained of abdominal distention, bloating, and a change in bowel habits from two days ago. On physical examination, bilateral enlarged masses of flanks, generalized tenderness, and distention of the abdomen were found. The patient received conventional therapy. After appropriate fluid and electrolyte management and rescue care, appropriate antibiotics were prescribed, and laparotomy was performed. The rupture of an infected cyst of the right polycystic kidney into the peritoneal cavity was the cause of peritonitis in this patient. She successfully underwent a right radical nephrectomy (32×21cm, and 3,300 gr). The postoperative period was uneventful and the patient was discharged from the hospital after a week.

Antibiotic therapy is the first step in the treatment of renal cyst infection. When primary antibiotic therapy fails, drainage of the infected cyst is recommended. In medically fit patients for surgery and patients who present with complications of the infected cyst, radical surgery and nephrectomy is the procedure of choice. The best outcome is achieved after nephrectomy.