Background: A 51 year old, Chinese post-menopausal lady with end stage renal disease. She was on Continuous Ambulatory Peritoneal Dialysis (CAPD) for 10 years with two documented episodes of peritonitis. She had tertiary hyperparathyroidism, and was planned for parathyroidectomy, which she postponed. She had hypercholesterolemia and hypertriglyceridemia.
Case Report: She presented with three days history of blood stained peritoneal fluid with epigastric discomfort, associated with nausea and vomiting. Abdomen examination revealed an infected skin lesion over her small umbilical hernia with erythema and pus. She was treated as sepsis, and was started on iv antibiotic. Serum amylase level was normal on two occasions and a corrected calcium of 2.52 mmol/l. Her condition worsened during the hospitalization. Draining out of peritoneal fluid seemed to aggravate the pain. Fluid drained out was dark red. CAPD was stopped, and she was started on hemodialysis. Pancreatitis was considered as a differential diagnosis. However, a repeated serum amylase was normal. She deteriorated on day 5 of admission despite resuscitation. An exploratory laporotomy revealed hemoperitoneum secondary to necrotizing pancreatitis with portal vein erosion.
She passed away on day 9 of admission.
Conclusions: Acute pancreatitis should be one of the important differential diagnosis in CAPD patients presented with abdominal pain. CAPD patients have higher risk of developing pancreatitis due to traditional risk factors, and also non-traditional risk factors.

Keywords: peritonitis, Hypercalcemia, Hypertriglyceridemia