LAUSR

A 62-year-old man receiving peritoneal dialysis (PD) visited our hospital because of fever, periumbilical dull pain, and cloudy PD effluent. His physical examination showed tenderness and muscular defense throughout the entire abdomen. Blood examination indicated leukocytosis and an increase in CRP. A large number of neutrophils were found in his PD fluid. These findings were sufficient for the diagnosis of peritonitis. Before starting antibiotic therapy, abdominal computed tomography (CT) was performed. Surprisingly, a linear fish bone that extended transmurally through the sigmoid colon wall was detected (Fig. 1). Immediately it was removed surgically, and the perforated colon was covered. Based on the PD guidelines [1], neither CT nor X-ray have been recommended for the initial evaluation of peritonitis. However, the physicians should consider using these modalities to detect and/or rule out such a rare condition.