Reviewer’s report
Title: 
Perforation of the ascending colon during implantation of an indwelling
peritoneal catheter: a case report
Version: 
0 
Date: 
06 Jul 2020
Reviewer: 
Research Square Reviewer 1
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
RELEVANCE - Does this case report make a contribution to medical
knowledge, have educational value, or highlight the need for a change in clinical
practice or diagnostic/prognostic approaches? 
Yes, this report contributes to medical knowledge
CASE DESCRIPTION - Are the details of the case sufficiently well described to
understand the patient's symptoms and course of treatment? 
No - there are minor issues
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the
diagnosis, interpretation, and course of treatment medically sound?
Yes, the work described is medically sound
DISCUSSION OF THE CASE - Does the discussion appropriately analyse the
importance of the findings and their relevance to future understanding of disease
processes, diagnosis or treatment? Has an adequate literature review pertinent to
the case been included?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Could an appropriately REVISED
version of this work represent a technically sound contribution?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: What is your overall impression of the report? 
This is a good case report that warns other physicians that percutaneous
placement of a tunneled peritoneal dialysis catheter should not be done 
in
patients with intraperitoneal adhesions because the catheter can injure the bowel
in insertion EVEN IF DIRECTED BY ULTRASONOGRAPHY..
Are you confident in the authors' description and interpretation of the report? 
Yes and no please see point #8 below. The patient 
developed "ischemic
perforation" in the same area of the original injury that was close at the time of
laparotomy, raising the question of whether it was 
a perforation( inadequate
operative closure) 
that will be questioned. Otherwise this is an educational case
report
Have the authors clearly outlined the need for publication by novelty of the case
or the specific adverse event? 
Yes I think that they have but their last sentence needs to be changed see point
#14 below concerning the adverse event 
Any patient with known adhesions
should not have a percutaneous placement of a peritoneal dialysis catheter!
REQUESTED REVISIONS: 
Suggested changes 
1. title 
page 2 line 7 , page 3 line 12, 
and figure 1 legend -----change "colon
ascendens perforation" 
to "perforation of the ascending colon""
2. Page 2 line 14 change to " because of extensive ascites , we decided to place a
tunneled peritoneal drainage catheter to enable appropriate lung-protective
ventilation ( Authors do you really mean "lung protective ventilation" or rather
"To enable appropriate ventilation"?) Also how was the catheter placed ?
Percutaneously with or without radiographic guidance or by an open
minilaparotomy? 
This needs to be added here, I see that 
later in the text 
it was
placed percutaneously under ultrasonographic guidance - I would add this to the
sentence
3. Page 2 line 17 change to "Notably, there was no pneumoperitoneum 
and
peritonitis had not yet set in". 
4 page 2 line 20 at the time of operation was another catheter placed?
5. 
Page 3 line 2- what is hydropic decompensations"? I would change this to "
refractory massive ascites"
6. Page 3 line 21 change to "We decided to establish drainage of the ascites " 
7. Page 3 line 41 replace "saturation" with " sutured closure"
8. Page E line 44 replace "right postoperatively" by "X days ( or X hours)
postoperatively"
9. Line 46. This sentence needs to be redone. Where was this spontaneous
perforation? If In the ascending colon, then it is 
much more likely due either to a
missed second perforation or to an ineffective colonic closure of the perforation
site-sorry but that is what the reader will suspect. 
In contrast, if the perforation
was distant to the site of drainage tube injury, then define it as such- I am a bit
concerned because most ischemic perforations occur in the ascending colon.
Thus you really need to define where this spontaneous perforation occurred and
that it was not at the site of drainage tube injury. Sorry ( remember that I am
NOT accusing you of this!!!!) but the readers and editor may believe that by
saying an ischemic perforation that you are trying time cover up a technical
injury related to the wrong decision of placing the catheter percutaneously or the
decision at the time of first laparotomy to just close the injury site. 
10. 
Page 3 line 55 add the word "percutaneous " before the word "tunneled" and
on line 56 
end the sentence by adding the phrase "In patients without known
adhesions"
11. Page 4 lines 3 and 4. 
I would strongly suggest that you add 
the phrase " may
have been" rather than "got". 
12. Page 4 line 15 the phrase "ultimate ratio" is meaningless to me 
change to "
the last resort" Be prepared , you also could have treated this patient
laparoscopically to repair the sites of perforation using a tunneled insertion of
the laparoscopy ports.You may want to add this to the discussion but say that
you believed 
that a laparotomy was most appropriate in this patient. 
13. Page 4 line 21 I would change the start of the sentence to 
"In retrospect" and
on line 23 the word "sub-ileus " is not a word
14. Finally I do NOT agree with your last sentence. I think that in such patients
with known adhesions as in your patient, an open insertion of the catheter should
be done by a minilaparotomy and not placed percutaneously--- 
No imaging
technique will be able to define a safe site in these patients with adhesions!!!!!
15. is figure 1 necessary? If so combine figures 1 and 2 into figure 1a and 1 b
cheaper and easier for the journal
ADDITIONAL REQUESTS/SUGGESTIONS: 
see ABOVE FOR COMPREHENSIVE SUGGESTIONS
Publons Reviewer Recognition
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No
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.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify 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:
Needs some language corrections before being published
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, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that 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
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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.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my
report.
Reviewer’s report
Title: 
Perforation of the ascending colon during implantation of an indwelling
peritoneal catheter: a case report
Version: 
0 
Date: 
06 Jul 2020
Reviewer: 
Research Square Reviewer 1
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
RELEVANCE - Does this case report make a contribution to medical
knowledge, have educational value, or highlight the need for a change in clinical
practice or diagnostic/prognostic approaches? 
Yes, this report contributes to medical knowledge
CASE DESCRIPTION - Are the details of the case sufficiently well described to
understand the patient's symptoms and course of treatment? 
No - there are minor issues
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the
diagnosis, interpretation, and course of treatment medically sound?
Yes, the work described is medically sound
DISCUSSION OF THE CASE - Does the discussion appropriately analyse the
importance of the findings and their relevance to future understanding of disease
processes, diagnosis or treatment? Has an adequate literature review pertinent to
the case been included?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Could an appropriately REVISED
version of this work represent a technically sound contribution?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: What is your overall impression of the report? 
This is a good case report that warns other physicians that percutaneous
placement of a tunneled peritoneal dialysis catheter should not be done 
in
patients with intraperitoneal adhesions because the catheter can injure the bowel
in insertion EVEN IF DIRECTED BY ULTRASONOGRAPHY..
Are you confident in the authors' description and interpretation of the report? 
Yes and no please see point #8 below. The patient 
developed "ischemic
perforation" in the same area of the original injury that was close at the time of
laparotomy, raising the question of whether it was 
a perforation( inadequate
operative closure) 
that will be questioned. Otherwise this is an educational case
report
Have the authors clearly outlined the need for publication by novelty of the case
or the specific adverse event? 
Yes I think that they have but their last sentence needs to be changed see point
#14 below concerning the adverse event 
Any patient with known adhesions
should not have a percutaneous placement of a peritoneal dialysis catheter!
REQUESTED REVISIONS: 
Suggested changes 
1. title 
page 2 line 7 , page 3 line 12, 
and figure 1 legend -----change "colon
ascendens perforation" 
to "perforation of the ascending colon""
2. Page 2 line 14 change to " because of extensive ascites , we decided to place a
tunneled peritoneal drainage catheter to enable appropriate lung-protective
ventilation ( Authors do you really mean "lung protective ventilation" or rather
"To enable appropriate ventilation"?) Also how was the catheter placed ?
Percutaneously with or without radiographic guidance or by an open
minilaparotomy? 
This needs to be added here, I see that 
later in the text 
it was
placed percutaneously under ultrasonographic guidance - I would add this to the
sentence
3. Page 2 line 17 change to "Notably, there was no pneumoperitoneum 
and
peritonitis had not yet set in". 
4 page 2 line 20 at the time of operation was another catheter placed?
5. 
Page 3 line 2- what is hydropic decompensations"? I would change this to "
refractory massive ascites"
6. Page 3 line 21 change to "We decided to establish drainage of the ascites " 
7. Page 3 line 41 replace "saturation" with " sutured closure"
8. Page E line 44 replace "right postoperatively" by "X days ( or X hours)
postoperatively"
9. Line 46. This sentence needs to be redone. Where was this spontaneous
perforation? If In the ascending colon, then it is 
much more likely due either to a
missed second perforation or to an ineffective colonic closure of the perforation
site-sorry but that is what the reader will suspect. 
In contrast, if the perforation
was distant to the site of drainage tube injury, then define it as such- I am a bit
concerned because most ischemic perforations occur in the ascending colon.
Thus you really need to define where this spontaneous perforation occurred and
that it was not at the site of drainage tube injury. Sorry ( remember that I am
NOT accusing you of this!!!!) but the readers and editor may believe that by
saying an ischemic perforation that you are trying time cover up a technical
injury related to the wrong decision of placing the catheter percutaneously or the
decision at the time of first laparotomy to just close the injury site. 
10. 
Page 3 line 55 add the word "percutaneous " before the word "tunneled" and
on line 56 
end the sentence by adding the phrase "In patients without known
adhesions"
11. Page 4 lines 3 and 4. 
I would strongly suggest that you add 
the phrase " may
have been" rather than "got". 
12. Page 4 line 15 the phrase "ultimate ratio" is meaningless to me 
change to "
the last resort" Be prepared , you also could have treated this patient
laparoscopically to repair the sites of perforation using a tunneled insertion of
the laparoscopy ports.You may want to add this to the discussion but say that
you believed 
that a laparotomy was most appropriate in this patient. 
13. Page 4 line 21 I would change the start of the sentence to 
"In retrospect" and
on line 23 the word "sub-ileus " is not a word
14. Finally I do NOT agree with your last sentence. I think that in such patients
with known adhesions as in your patient, an open insertion of the catheter should
be done by a minilaparotomy and not placed percutaneously--- 
No imaging
technique will be able to define a safe site in these patients with adhesions!!!!!
15. is figure 1 necessary? If so combine figures 1 and 2 into figure 1a and 1 b
cheaper and easier for the journal
ADDITIONAL REQUESTS/SUGGESTIONS: 
see ABOVE FOR COMPREHENSIVE SUGGESTIONS
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
No
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.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify 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:
Needs some language corrections before being published
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, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that 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.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my
report.
Please review this paper.
user
Reviewer’s report
Title: 
Perforation of the ascending colon during implantation of an indwelling
peritoneal catheter: a case report
Version: 
0 
Date: 
06 Jul 2020
Reviewer: 
Research Square Reviewer 1
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
RELEVANCE - Does this case report make a contribution to medical
knowledge, have educational value, or highlight the need for a change in clinical
practice or diagnostic/prognostic approaches? 
Yes, this report contributes to medical knowledge
CASE DESCRIPTION - Are the details of the case sufficiently well described to
understand the patient's symptoms and course of treatment? 
No - there are minor issues
DIAGNOSIS/INTERPRETATION - Based on the facts presented, are the
diagnosis, interpretation, and course of treatment medically sound?
Yes, the work described is medically sound
DISCUSSION OF THE CASE - Does the discussion appropriately analyse the
importance of the findings and their relevance to future understanding of disease
processes, diagnosis or treatment? Has an adequate literature review pertinent to
the case been included?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Could an appropriately REVISED
version of this work represent a technically sound contribution?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: What is your overall impression of the report? 
This is a good case report that warns other physicians that percutaneous
placement of a tunneled peritoneal dialysis catheter should not be done 
in
patients with intraperitoneal adhesions because the catheter can injure the bowel
in insertion EVEN IF DIRECTED BY ULTRASONOGRAPHY..
Are you confident in the authors' description and interpretation of the report? 
Yes and no please see point #8 below. The patient 
developed "ischemic
perforation" in the same area of the original injury that was close at the time of
laparotomy, raising the question of whether it was 
a perforation( inadequate
operative closure) 
that will be questioned. Otherwise this is an educational case
report
Have the authors clearly outlined the need for publication by novelty of the case
or the specific adverse event? 
Yes I think that they have but their last sentence needs to be changed see point
#14 below concerning the adverse event 
Any patient with known adhesions
should not have a percutaneous placement of a peritoneal dialysis catheter!
REQUESTED REVISIONS: 
Suggested changes 
1. title 
page 2 line 7 , page 3 line 12, 
and figure 1 legend -----change "colon
ascendens perforation" 
to "perforation of the ascending colon""
2. Page 2 line 14 change to " because of extensive ascites , we decided to place a
tunneled peritoneal drainage catheter to enable appropriate lung-protective
ventilation ( Authors do you really mean "lung protective ventilation" or rather
"To enable appropriate ventilation"?) Also how was the catheter placed ?
Percutaneously with or without radiographic guidance or by an open
minilaparotomy? 
This needs to be added here, I see that 
later in the text 
it was
placed percutaneously under ultrasonographic guidance - I would add this to the
sentence
3. Page 2 line 17 change to "Notably, there was no pneumoperitoneum 
and
peritonitis had not yet set in". 
4 page 2 line 20 at the time of operation was another catheter placed?
5. 
Page 3 line 2- what is hydropic decompensations"? I would change this to "
refractory massive ascites"
6. Page 3 line 21 change to "We decided to establish drainage of the ascites " 
7. Page 3 line 41 replace "saturation" with " sutured closure"
8. Page E line 44 replace "right postoperatively" by "X days ( or X hours)
postoperatively"
9. Line 46. This sentence needs to be redone. Where was this spontaneous
perforation? If In the ascending colon, then it is 
much more likely due either to a
missed second perforation or to an ineffective colonic closure of the perforation
site-sorry but that is what the reader will suspect. 
In contrast, if the perforation
was distant to the site of drainage tube injury, then define it as such- I am a bit
concerned because most ischemic perforations occur in the ascending colon.
Thus you really need to define where this spontaneous perforation occurred and
that it was not at the site of drainage tube injury. Sorry ( remember that I am
NOT accusing you of this!!!!) but the readers and editor may believe that by
saying an ischemic perforation that you are trying time cover up a technical
injury related to the wrong decision of placing the catheter percutaneously or the
decision at the time of first laparotomy to just close the injury site. 
10. 
Page 3 line 55 add the word "percutaneous " before the word "tunneled" and
on line 56 
end the sentence by adding the phrase "In patients without known
adhesions"
11. Page 4 lines 3 and 4. 
I would strongly suggest that you add 
the phrase " may
have been" rather than "got". 
12. Page 4 line 15 the phrase "ultimate ratio" is meaningless to me 
change to "
the last resort" Be prepared , you also could have treated this patient
laparoscopically to repair the sites of perforation using a tunneled insertion of
the laparoscopy ports.You may want to add this to the discussion but say that
you believed 
that a laparotomy was most appropriate in this patient. 
13. Page 4 line 21 I would change the start of the sentence to 
"In retrospect" and
on line 23 the word "sub-ileus " is not a word
14. Finally I do NOT agree with your last sentence. I think that in such patients
with known adhesions as in your patient, an open insertion of the catheter should
be done by a minilaparotomy and not placed percutaneously--- 
No imaging
technique will be able to define a safe site in these patients with adhesions!!!!!
15. is figure 1 necessary? If so combine figures 1 and 2 into figure 1a and 1 b
cheaper and easier for the journal
ADDITIONAL REQUESTS/SUGGESTIONS: 
see ABOVE FOR COMPREHENSIVE SUGGESTIONS
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
No
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.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify 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:
Needs some language corrections before being published
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, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that 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.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please publish my name with my
report.
assistant