Reviewer ’s report  
 
Title: Intestinal fistula accompanied by recurrent peritonitis associa ted with peritoneal dialys is: a 
case report  
 
Version: 1 Date: 19 Mar 2020  
 
Reviewer: Luca Nardelli  
 
Reviewer's report:  
 
35-36  "Repeated peritonitis (more than 4 weeks) due to the peritoneal dialysis had not been 
regularly". What are the words in the brackets referred to?. It's still missing pivotal info 
concerning the peritonitis episodes and their characteri zation/management.  
 
36-37 it has not been reported the analysis which were performed on the fluid noted at the exit -
site. Why, for instance , might it be not an exudative drainage? a pure leakage does not involve 
inflammatory features and it shows a very high quantity of glucose according to the instilled 
peritoneal solution.  
 
Fig. 1 (a,b) --&gt; the presence of abdominal radiography is not mentioned.  
 
80-82 "The main methods of catheter insertion are the Moncrief and Popovich technique and the 
peritoneal wall -anchor technique; both techniques have been used in  a low percentage (0.2%) of 
patients".  
 
Nowadays the modalities of PD catheter insertion are n umerous and the choice depends mostly 
on the experience of the specific center (percutaneous, semi -surgical, surgical...).  
 
The Moncrief -Popovich technique (catheter embedding) consists of inserting PD catheter far in 
advance of anticipated need. Instead o f bringing the external limb of the catheter out to the 
surface, it is embedded under the skin in the subcutaneous space. When the patient needs to start 
dialysis, the external limb is brought to the outside through a small incision. This technique can 
be incorporated into any of the insertion approaches. Thus, it is not a specific modality of PD 
catheter placement rather a "special access techniques" and it is not so widely employed. the 
PWAT is an ancillary technique, too. It is performed either by laparo scopy or open surgery in 
order to eliminate the movement of the catheter in the peritoneal cavity. It is widely used in 
Japan, but it is not introduced worldwide.  
 
So, the statement is not appropriate. Furthermore, the sentence seems to be contradictory in 
itself.  
 
80-93 what do the Authors want to point out (that te perforation in this case is due to pd 
discontinuation?) The perforation due to the presence of unused PD catheter is reported very 
rarely. Did the patient interrupt the PD anytime due to the pe ritonitis episodes?  
 
Anyway, the Authors should clarify and state clearly why do they believe that it does exist a 
correlation between the past peritonitis episodes and the perforation? On what basis is the 
assumption suggested?  
 
What is the alleged link ( even indirect) of cause and effect?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the  conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statisti cal review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain  or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future? 
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of  the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
'I declare that I have no competing interests'  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is ac cepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Intestinal fistula accompanied by recurrent peritonitis associa ted with peritoneal dialys is: a 
case report  
 
Version: 1 Date: 19 Mar 2020  
 
Reviewer: Luca Nardelli  
 
Reviewer's report:  
 
35-36  "Repeated peritonitis (more than 4 weeks) due to the peritoneal dialysis had not been 
regularly". What are the words in the brackets referred to?. It's still missing pivotal info 
concerning the peritonitis episodes and their characteri zation/management.  
 
36-37 it has not been reported the analysis which were performed on the fluid noted at the exit -
site. Why, for instance , might it be not an exudative drainage? a pure leakage does not involve 
inflammatory features and it shows a very high quantity of glucose according to the instilled 
peritoneal solution.  
 
Fig. 1 (a,b) --&gt; the presence of abdominal radiography is not mentioned.  
 
80-82 "The main methods of catheter insertion are the Moncrief and Popovich technique and the 
peritoneal wall -anchor technique; both techniques have been used in  a low percentage (0.2%) of 
patients".  
 
Nowadays the modalities of PD catheter insertion are n umerous and the choice depends mostly 
on the experience of the specific center (percutaneous, semi -surgical, surgical...).  
 
The Moncrief -Popovich technique (catheter embedding) consists of inserting PD catheter far in 
advance of anticipated need. Instead o f bringing the external limb of the catheter out to the 
surface, it is embedded under the skin in the subcutaneous space. When the patient needs to start 
dialysis, the external limb is brought to the outside through a small incision. This technique can 
be incorporated into any of the insertion approaches. Thus, it is not a specific modality of PD 
catheter placement rather a "special access techniques" and it is not so widely employed. the 
PWAT is an ancillary technique, too. It is performed either by laparo scopy or open surgery in 
order to eliminate the movement of the catheter in the peritoneal cavity. It is widely used in 
Japan, but it is not introduced worldwide.  
 
So, the statement is not appropriate. Furthermore, the sentence seems to be contradictory in 
itself.  
 
80-93 what do the Authors want to point out (that te perforation in this case is due to pd 
discontinuation?) The perforation due to the presence of unused PD catheter is reported very 
rarely. Did the patient interrupt the PD anytime due to the pe ritonitis episodes?  
 
Anyway, the Authors should clarify and state clearly why do they believe that it does exist a 
correlation between the past peritonitis episodes and the perforation? On what basis is the 
assumption suggested?  
 
What is the alleged link ( even indirect) of cause and effect?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the  conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statisti cal review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain  or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future? 
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of  the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
'I declare that I have no competing interests'  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is ac cepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Intestinal fistula accompanied by recurrent peritonitis associa ted with peritoneal dialys is: a 
case report  
 
Version: 1 Date: 19 Mar 2020  
 
Reviewer: Luca Nardelli  
 
Reviewer's report:  
 
35-36  "Repeated peritonitis (more than 4 weeks) due to the peritoneal dialysis had not been 
regularly". What are the words in the brackets referred to?. It's still missing pivotal info 
concerning the peritonitis episodes and their characteri zation/management.  
 
36-37 it has not been reported the analysis which were performed on the fluid noted at the exit -
site. Why, for instance , might it be not an exudative drainage? a pure leakage does not involve 
inflammatory features and it shows a very high quantity of glucose according to the instilled 
peritoneal solution.  
 
Fig. 1 (a,b) --&gt; the presence of abdominal radiography is not mentioned.  
 
80-82 "The main methods of catheter insertion are the Moncrief and Popovich technique and the 
peritoneal wall -anchor technique; both techniques have been used in  a low percentage (0.2%) of 
patients".  
 
Nowadays the modalities of PD catheter insertion are n umerous and the choice depends mostly 
on the experience of the specific center (percutaneous, semi -surgical, surgical...).  
 
The Moncrief -Popovich technique (catheter embedding) consists of inserting PD catheter far in 
advance of anticipated need. Instead o f bringing the external limb of the catheter out to the 
surface, it is embedded under the skin in the subcutaneous space. When the patient needs to start 
dialysis, the external limb is brought to the outside through a small incision. This technique can 
be incorporated into any of the insertion approaches. Thus, it is not a specific modality of PD 
catheter placement rather a "special access techniques" and it is not so widely employed. the 
PWAT is an ancillary technique, too. It is performed either by laparo scopy or open surgery in 
order to eliminate the movement of the catheter in the peritoneal cavity. It is widely used in 
Japan, but it is not introduced worldwide.  
 
So, the statement is not appropriate. Furthermore, the sentence seems to be contradictory in 
itself.  
 
80-93 what do the Authors want to point out (that te perforation in this case is due to pd 
discontinuation?) The perforation due to the presence of unused PD catheter is reported very 
rarely. Did the patient interrupt the PD anytime due to the pe ritonitis episodes?  
 
Anyway, the Authors should clarify and state clearly why do they believe that it does exist a 
correlation between the past peritonitis episodes and the perforation? On what basis is the 
assumption suggested?  
 
What is the alleged link ( even indirect) of cause and effect?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the  conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statisti cal review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain  or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future? 
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of  the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
'I declare that I have no competing interests'  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is ac cepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant