Reviewer ’s report  
 
Title: Intestinal fistula acc ompanied by recurrent peritonitis associa ted with peritoneal dialysis: a 
case report  
 
Version: 0 Date: 16 Feb 2020  
 
Reviewer: Luca Nardelli  
 
Reviewer's report:  
 
1 What significance do the Au thors confer to the term "fistula"? Here it seems to be employed 
with the same meaning of perforation (which always involve a communication between the 
peritoneal cavity and intestinal lumen). For instance, the reported citation (Yanai 2018) used the 
term fistula to describe the formation of a fistula between a side hole of the PD catheter and the 
bowel lumen.  
 
 
BACKGROUND  
 
22 the term "nephropathy" is too generic, in fact  only a minor percentage of patients affected by 
CKD or AKI reaches ESRD which actuall y requires a substitute renal therapy (PD/HD or kidney 
transplant).  
 
23 "feculent dialysate effluent with watery diarrhea" is not really a common PD complication.  
 
 
CASE PRESENTATION  
 
29 What is the underlying renal disease of the (young) patient? and what about his medical 
history? it's important to report!  
 
31 What type of PD was  the patient on (CAPD, APD...)? What kind of PD catheter was placed?.  
 
32 How many peritonitis did the patients have during the 6 years of PD treatment? What were 
the isolated micro organisms? How was the seriousness of the peritonitis episodes? How were 
peritonitis events treated (what does mean ""peritonitis had been not regularly treated"?)? all 
these info are not stated at all!  
 
33 Why did the patient show a leakage episode around the exit -site in May 2019?  
 
34 When the patient developed chills and fever, did blood or/and dialysis effluent culture 
perform? What about microscopy analysys of peritoneal dialysate?  
 
40 Why did not CT reveal an intestinal perforation? Was not injected a co ntrast dissolved in the 
PD solution via the PD catheter during the CT?  
42-45 Did the colonoscopy reveal other significant characteristics (e.g. diverticula, wall 
inflammation or atrophy...)? Did an intestinal biopsy perform?  
 
63 Why do the authors suspect that repeat peritonitis lead to intestinal perforation?  
 
64 According to the most recent ISPD Guidelines Repeat peritonitis was defined as an episode 
that occurs more than 4 weeks after completion of therapy of a prior episode with the same 
organism. How d id the author use the term "repeated peritoneal dialysis -related peritonitis"? no 
essential info concerning those episodes are reported in the case presentation.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does th e work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the aut hors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical 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:  
 
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, f ees, funding, or salary 
from an organisation that may in any way gain or lose financially from the 
publicati on 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 currentl y 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 oth er 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 accepted 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 acc ompanied by recurrent peritonitis associa ted with peritoneal dialysis: a 
case report  
 
Version: 0 Date: 16 Feb 2020  
 
Reviewer: Luca Nardelli  
 
Reviewer's report:  
 
1 What significance do the Au thors confer to the term "fistula"? Here it seems to be employed 
with the same meaning of perforation (which always involve a communication between the 
peritoneal cavity and intestinal lumen). For instance, the reported citation (Yanai 2018) used the 
term fistula to describe the formation of a fistula between a side hole of the PD catheter and the 
bowel lumen.  
 
 
BACKGROUND  
 
22 the term "nephropathy" is too generic, in fact  only a minor percentage of patients affected by 
CKD or AKI reaches ESRD which actuall y requires a substitute renal therapy (PD/HD or kidney 
transplant).  
 
23 "feculent dialysate effluent with watery diarrhea" is not really a common PD complication.  
 
 
CASE PRESENTATION  
 
29 What is the underlying renal disease of the (young) patient? and what about his medical 
history? it's important to report!  
 
31 What type of PD was  the patient on (CAPD, APD...)? What kind of PD catheter was placed?.  
 
32 How many peritonitis did the patients have during the 6 years of PD treatment? What were 
the isolated micro organisms? How was the seriousness of the peritonitis episodes? How were 
peritonitis events treated (what does mean ""peritonitis had been not regularly treated"?)? all 
these info are not stated at all!  
 
33 Why did the patient show a leakage episode around the exit -site in May 2019?  
 
34 When the patient developed chills and fever, did blood or/and dialysis effluent culture 
perform? What about microscopy analysys of peritoneal dialysate?  
 
40 Why did not CT reveal an intestinal perforation? Was not injected a co ntrast dissolved in the 
PD solution via the PD catheter during the CT?  
42-45 Did the colonoscopy reveal other significant characteristics (e.g. diverticula, wall 
inflammation or atrophy...)? Did an intestinal biopsy perform?  
 
63 Why do the authors suspect that repeat peritonitis lead to intestinal perforation?  
 
64 According to the most recent ISPD Guidelines Repeat peritonitis was defined as an episode 
that occurs more than 4 weeks after completion of therapy of a prior episode with the same 
organism. How d id the author use the term "repeated peritoneal dialysis -related peritonitis"? no 
essential info concerning those episodes are reported in the case presentation.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does th e work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the aut hors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical 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:  
 
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, f ees, funding, or salary 
from an organisation that may in any way gain or lose financially from the 
publicati on 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 currentl y 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 oth er 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 accepted 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 acc ompanied by recurrent peritonitis associa ted with peritoneal dialysis: a 
case report  
 
Version: 0 Date: 16 Feb 2020  
 
Reviewer: Luca Nardelli  
 
Reviewer's report:  
 
1 What significance do the Au thors confer to the term "fistula"? Here it seems to be employed 
with the same meaning of perforation (which always involve a communication between the 
peritoneal cavity and intestinal lumen). For instance, the reported citation (Yanai 2018) used the 
term fistula to describe the formation of a fistula between a side hole of the PD catheter and the 
bowel lumen.  
 
 
BACKGROUND  
 
22 the term "nephropathy" is too generic, in fact  only a minor percentage of patients affected by 
CKD or AKI reaches ESRD which actuall y requires a substitute renal therapy (PD/HD or kidney 
transplant).  
 
23 "feculent dialysate effluent with watery diarrhea" is not really a common PD complication.  
 
 
CASE PRESENTATION  
 
29 What is the underlying renal disease of the (young) patient? and what about his medical 
history? it's important to report!  
 
31 What type of PD was  the patient on (CAPD, APD...)? What kind of PD catheter was placed?.  
 
32 How many peritonitis did the patients have during the 6 years of PD treatment? What were 
the isolated micro organisms? How was the seriousness of the peritonitis episodes? How were 
peritonitis events treated (what does mean ""peritonitis had been not regularly treated"?)? all 
these info are not stated at all!  
 
33 Why did the patient show a leakage episode around the exit -site in May 2019?  
 
34 When the patient developed chills and fever, did blood or/and dialysis effluent culture 
perform? What about microscopy analysys of peritoneal dialysate?  
 
40 Why did not CT reveal an intestinal perforation? Was not injected a co ntrast dissolved in the 
PD solution via the PD catheter during the CT?  
42-45 Did the colonoscopy reveal other significant characteristics (e.g. diverticula, wall 
inflammation or atrophy...)? Did an intestinal biopsy perform?  
 
63 Why do the authors suspect that repeat peritonitis lead to intestinal perforation?  
 
64 According to the most recent ISPD Guidelines Repeat peritonitis was defined as an episode 
that occurs more than 4 weeks after completion of therapy of a prior episode with the same 
organism. How d id the author use the term "repeated peritoneal dialysis -related peritonitis"? no 
essential info concerning those episodes are reported in the case presentation.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does th e work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the aut hors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical 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:  
 
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, f ees, funding, or salary 
from an organisation that may in any way gain or lose financially from the 
publicati on 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 currentl y 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 oth er 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 accepted 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