During a night call in my first year of nephrology fellowship, I was asked a question that I had never heard before: ‘What do we do when we see black effluent draining out of the peritoneal dialysis (PD) catheter?’
With a detailed literature review, investigations and discussion on rounds, we were able to determine that this black color was due to the leakage of india ink into the peritoneum from a colonoscopy earlier in the day.
As we encounter more patients on PD, it is important to review the different colorful aberrations in peritoneal effluent that have been reported in the medical literature so far.
| Color | Possible Etiologies |
Black or Black-Brown |
|
Brown or Greenish-Brown |
|
Fluorescent Yellow |
|
Orange |
|
Purple (not seen anymore) |
|
Peach Color |
|
Milky White (Chyloperitoneum) |
|
Red (Hemoperitoneum) |
|
|
Cloudy |
|
As we can see from the table above, the color of the peritoneal effluent can be a clue to complex pathophysiologies within the human body. It is important to keep these differentials in mind when encountered with such a situation. I wanted to highlight the work of Thomas Dossin and Eric Goffin who provided photographs with a comprehensive review of this topic. Other articles and pictures have been referenced through the hyperlinks provided.
Management depends on the etiology but prompt investigation is warranted. There have been recent updates to the ISPD guidelines which talk about possible strategies to deal with such situations.
Post by: Arrsh Bajaj
Bluesky: @drcoolbeans.bsky.social
Reviewed by: Samira Farouk, Matthew A. Sparks
