Green dialysate: asymptomatic perforated cholecystitis without peritonitis
Bibliographic record
Abstract
1Division of Nephrology and 2Nuclear Medicine, Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec Hospital and Department of Medicine, Faculty of Medicine, Laval University, Québec, Canada In peritoneal dialysis, the effluent dialysate is the window of the peritoneal cavity and usually allows for a rapid diagnosis of peritonitis and abdominal drama [1]. To our knowledge, there is only one reported case of perforation of the gallbladder in a patient on peritoneal dialysis with gram negative peritonitis [2]. We describe a case of asymptomatic perforated cholecystitis without peritonitis in a patient on continuous ambulatory peritoneal dialysis. A 53-year-old male patient with type 1 diabetes, on peritoneal dialysis for 8 years, came to the dialysis clinic because of green dialysate. During the previous month, he had noticed black particles in his dialysate. He denied any abdominal pain, nausea, vomiting or anorexia. A cellular count and culture of the dialysis fluid were normal the week prior. The patient looked well, had normal blood pressure and normal temperature; the abdominal exam was unremarkable. Upon examination, the bag of dialysate was indeed dark green (Figure 1). Blood chemistry showed a white cell count of 12.5×109/l, a total bilirubin level of of 27 µmol/l (N = 3–17) (indirect 23), a GGT level of 82 U/l (N = 7–32), an alkaline phosphatase activity of 431 U/l (N = 32–120) and normal AST, ALT, amylase and lipase levels. The peritoneal fluid showed 46×109/l nucleated cells and a total bilirubin level of 10 µmol/l. Peritoneal fluid culture was again negative. A Tc99m-disofenin (IDA) cholecysto-scintigram did not show any direct biliary leak but the bag of dialysate did reveal a significant level of radioactivity, suggesting the passage of bile into the peritoneal cavity (Figure 2). An abdominal computed tomography scan revealed a gallbladder with thickened walls without free air but no signs of bowel perforation.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".