This case involves an elderly patient with end stage renal disease on peritoneal dialysis who presented to the emergency room with complaints of abdominal pain and bleeding. He notified doctors that he had recently had his dialysis replaced. Combined with his symptoms, there was a concern that the patient had a bowel perforation. A CT scan prior to his surgery confirmed that his dialysis had perforated his colon. His nephrologist was consulted and the patient was transferred to a nearby facility better equipped for the surgery.