Hemoperitoneum requiring surgical exploration developed in association with an indwelling chronic peritoneal dialysis catheter. Major intra-abdominal hemorrhage in continuous ambulatory peritoneal dialysis (CAPD) has not been previously reported. Radiation therapy for carcinoma of the bladder and subsequent radiation induced peritoneal injury appears to have predisposed this patient to develop catheter-related trauma and hemorrhage. Antecedent radiation therapy with its possible deleterious effects on the peritoneal membrane may subject potential CAPD patients to unique risks and should be considered in the decision to choose CAPD as a form of treatment for end stage renal disease.