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It is my understanding that the female peritoneum does not form a closed (potential) space due to its puncture by the uterine tubes. If that is indeed the case, why is peritoneal dialysis in women not typically complicated by vaginal leakage of dialysate? Similarly, why do we not expect surgical insufflation (e.g. in laparoscopy) to suffer from CO2 leakage via the same route? Does this have to do with muscle tone in the fallopian tubes, or a duckbill valve effect where intraperitoneal pressure effectively seals them off? There seem to be only a handful of case reports of PD dialysate leakage, but more suggesting flow in the other direction where sexual activity, for example, resulted in unintended pneumoperitoneum.

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