What is omental wrapping in PD, and how is it managed?

• A. Omentum wraps around the catheter causing obstruction.
• B. Omentum reduces catheter function and improves flow.
• C. Omentum has no effect on the catheter.
• D. Omentum causes infection.

Answer: (A)

Omental wrapping around a peritoneal dialysis catheter can obstruct the catheter, causing poor drainage and dysfunctional flow. The omentum is a mobile fatty fold in the abdomen, and when it loops or adheres around the catheter, it can kink or block the catheter, preventing proper inflow and outflow of dialysate.

Management is surgical. The usual approach is to release the catheter from the wrapped omentum and prevent recurrence, commonly with omentopexy (securing the omentum away from the catheter) or omentectomy (removing the problematic portion of omentum). This is often done laparoscopically or via an open procedure. After freeing the catheter, function is reassessed; if needed, catheter repositioning or reinsertion may be performed. If recurrent wrapping makes PD unsuitable, switching to another modality, such as hemodialysis, may be considered.