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Sclerosing encapsulating peritonitis; silent danger in continuous ambulatory peritoneal dialysis patients: case report and review of the literature

Year 2013, Volume: 35 Issue: 1, 113 - 119, 22.03.2013

Gürsel Yıldız Abdulkerim Yılmaz İbrahim Öztoprak Ferhan Candan Mansur Kayataş

Abstract

Abstract

Sclerosing encapsulating peritonitis is a rare complication of continuous ambulatory peritoneal dialysis. Sclerosing encapsulating peritonitis causes weight loss, intermittent bowel obstruction and decrease in peritoneal water and solute transport. Mortality may reach up to 50% due to severe malnutrition and ileus. Although the etiology is not fully known, many reasons such as frequent peritonitis attacks, bio-incompatibility of dialysate and catheter, intra-peritoneal contamination with clorhexidine, and use of beta-blockers are held responsible. Diagnosis is difficult in early stage. In this stage, abdominal computed tomography findings are important. It is often diagnosed during operation of the patients who developed complications such as bowel obstruction. Termination of peritoneal dialysis and providing nutritional support, use of immunosuppressive drugs, and surgical approach can be used for treatment. In this article, a 46-year-old male who had been using continuous ambulatory peritoneal dialysis as a renal replacement therapy for 9 years, presenting with peritonitis attacks, severe abdominal paintogether with weight loss and was diagnosed as sclerosing encapsulating peritonitis is presented.

Keywords: Continuous ambulatory peritoneal dialysis, abdominal computerized tomography, sclerosing encapsulating peritonitis

 

Özet

Sklerozan enkapsüle peritonit, sürekli ayaktan periton diyalizinin nadir bir komplikasyonudur. Sklerozan enkapsüle peritonit kilo kaybı, aralıklı barsak tıkanması ve peritoneal su ve solid taşınmasında azalmaya neden olur. Mortalite oranı ağır malnütrisyon ve ileus nedeniyle %50’ye kadar ulaşabilir. Etyolojisi tam olarak bilinmemekle birlikte, sık peritonit atakları, diyalizat ve kateterin biyo-uyumsuzluğu, klorheksidinle intra-peritoneal kontaminasyon ve beta blokör kullanımı gibi birçok neden sorumlu tutulur. Erken dönemde tanısı zordur. Bu dönemde bilgisayarlı batın tomografisi bulguları önemlidir. Barsak tıkanması gibi komplikasyon gelişen hastalarda sıklıkla operasyon sırasında teşhis edilir. Periton diyalizini sonlandırmak, beslenme desteği sağlamak, immünsupresif ilaçların kullanımı ve cerrahi yaklaşım tedavi için uygulanabilir. Bu makalede dokuz yıldır renal replasman tedavisi olarak sürekli ayaktan periton diyalizi kullanmakta olan, peritonit atakları, şiddetli karın ağrısı ve kilo kaybı semptomları ile başvuran ve sklerozan enkapsüle peritonit tanısı alan 46 yaşında erkek olgu sunulmaktadır.

Anahtar sözcükler: Sürekli ayaktan periton diyalizi, bilgisayarlı batın tomografisi, sklerozan enkapsüle peritonit

Keywords

Continuous ambulatory peritoneal dialysis abdominal computerized tomography sclerosing encapsulating peritonitis

References

  • Chew MH, Sophian Hadi I, Chan G, Ong HS, Wong WK. A problem encapsulated: The rare peritoneal encapsulation syndrome. Singapore Med J 2006; 47: 808-10.
  • Xu P, Chen LH, Li YM. Idiopathic sclerosing encapsulating peritonitis (or abdominal cocoon): a report of 5 cases. World J Gastroenterol 2007; 13: 3649-51. Foo KT, Ng KC, Rauff A, Foong WC, Sinniah R. Unusual small intestinal obstruction in adolescent girls: the abdominal cocoon. Br J Surg 1978; 65: 427
  • Meng MV, Freise CE, Stoller ML. Sclerosing peritonitis. Urology 2003; 61: 1257Kim BS, Choi HY, Ryu DR, Yoo TH, Park HC, Kang SW, Choi KH, Ha SK, Han DS, Lee HY. Clinical characteristics of dialysis related sclerosing encapsulating peritonitis: multi-center experience in Korea. Yonsei Med J 2005; 46: 104-11.
  • Bozkurt D, Ertilav M, Duman S. Experimental Models of Sclerosing Peritonitis. Turkiye Klinikleri J Nephrol-Special Topics 2010; 3: 90-4.
  • Rigby R, Hawley CM. Sclerosing peritonitis: the experience in Australia. Nephrol Dial Transplant 1998; 13: 154-9.
  • Selgas R, Bajo A, Jiménez-Heffernan JA, Sánchez-Tomero JA, Del Peso G, Aguilera A, López-Cabrera M. Epithelial-to-mesenchymal transition of the mesothelial cell--its role in the response of the peritoneum to dialysis. Nephrol Dial Transplant 2006; 21 Suppl 2: 2-7.
  • Dobbie JW. Serositis: Comparative analysis of histological findings and pathogenetic mechanisms in nonbacterial serosal inflammation. Perit Dial Int 1993; 13: 256-9.
  • Cudazzo E, Lucchini A, Puviani PP, Dondi D, Binacchi S, Bianchi M, Franzini M. Sclerosing peritonitis. A complication of LeVeen peritoneovenous shunt. Minerva Chir 1999; 54: 809-12.
  • Stanley MM, Reyes CV, Greenlee HB, Nemchausky B, Reinhardt GF. Peritoneal fibrosis in cirrhotics treated with peritoneovenous shunting for ascites. An autopsy study with clinical correlations. Dig Dis Sci 1996; 41: 571-7.
  • Clement PB, Young RH, Hanna W, Scully RE. Sclerosing peritonitis associated with luteinized thecomas of the ovary. A clinicopathological analysis of six cases. Am J Surg Pathol 1994; 18: 1-13.
  • Chalasani R, Marella P. Sclerosing encapsulating peritonitis in a 47-year-old woman. Kidney International 2006; 70: 1673.
  • Faller B, Marichal JF, Brignon P. Local immunologic reactions induced by CAPD. Nephrologie 1989; 10 Suppl: 30-3.
  • Naiki Y, Maeda Y, Matsuo K, Yonekawa S, Sakaguchi M, Iwamoto I, Hasegawa H, Kanamaru A. Involvement of TGF-beta signal for peritoneal sclerosing in continuous ambulatory peritoneal dialysis. J Nephrol 2003; 16: 95-102.
  • George C, Al-Zwae K, Nair S, Cast JE. Computed tomography appearances of sclerosing encapsulating peritonitis. Clin Radiol 2007; 62: 732-7.
  • Kawaguchi Y, Kawanishi H, Mujais S, Topley N, Oreopoulos DG. Encapsulating peritoneal sclerosis: definition, etiology, diagnosis, and treatment. International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis. Perit Dial Int 2000; 20 Suppl 4: 43-55.
  • Stafford-Johnson DB, Wilson TE, Francis IR, Swartz R. CT Appearance of sclerosing peritonitis in patients on chronic ambulatory peritoneal dialysis. J Comput Assist Tomogr 1998; 22: 295-9.
  • Carcano G, Rovera F, Boni L, Dionigi G, Uccella L, Dionigi R. Idiopathic sclerosing encapsulating peritonitis: a case report. Chir Ital 2003; 55: 605-8.
  • Başaran C, Dönmez FY, Öztürk A, Tarhan NÇ, Sezer S, Coşkun M. Computerized tomography findings of sclerosing encapsulated peritonitis in the patients under CAPD treatment. Diyaliz Transplantasyon ve Yanık/Dialysis, Transplantation and Burns 2008; 19: 73-8.
  • Loughrey GJ, Hawnaur JM, Sambrook P. Case report: computed tomographic appearance of sclerosing peritonitis with gross peritoneal calcification. Clin Radiol 1997; 52: 557-8.
  • Nakamoto H. Encapsulating peritoneal sclerosis--a clinician's approach to diagnosis and medical treatment. Perit Dial Int 2005; 25 Suppl 4: 30-8.
  • Korzets A, Korzets Z, Peer G, Papo J, Stern D, Bernheim J, Blum M. Sclerosing peritonitis. Possible early diagnosis by computerized tomography of the abdomen. Am J Nephrol 1988; 8: 143-6.
  • Krestin GP, Kacl G, Hauser M, Keusch G, Burger HR, Hoffmann R. Imaging diagnosis of sclerosing peritonitis and relation of radiologic signs to the extent of the disease. Abdom Imaging 1995; 20: 414-20.
  • Cakir B, Kirbaş I, Cevik B, Ulu EM, Bayrak A, Coşkun M. Complications of continuous ambulatory peritoneal dialysis: evaluation with CT. Diagn Interv Radiol 2008; 14: 212-20.

Sklerozan enkapsüle peritonit; sürekli ayaktan periton diyalizi yapan hastalardaki sessiz tehlike: olgu sunumu ve literatürün gözden geçirilmesi

Year 2013, Volume: 35 Issue: 1, 113 - 119, 22.03.2013

Gürsel Yıldız Abdulkerim Yılmaz İbrahim Öztoprak Ferhan Candan Mansur Kayataş

Abstract

Sklerozan enkapsüle peritonit, sürekli ayaktan periton diyalizinin nadir bir komplikasyonudur. Sklerozan enkapsüle peritonit kilo kaybı, aralıklı barsak tıkanması ve peritoneal su ve solid taşınmasında azalmaya neden olur. Mortalite oranı ağır malnütrisyon ve ileus nedeniyle %50’ye kadar ulaşabilir. Etyolojisi tam olarak bilinmemekle birlikte, sık peritonit atakları, diyalizat ve kateterin biyo-uyumsuzluğu, klorheksidinle intra-peritoneal kontaminasyon ve beta blokör kullanımı gibi birçok neden sorumlu tutulur. Erken dönemde tanısı zordur. Bu dönemde bilgisayarlı batın tomografisi bulguları önemlidir. Barsak tıkanması gibi komplikasyon gelişen hastalarda sıklıkla operasyon sırasında teşhis edilir. Periton diyalizini sonlandırmak, beslenme desteği sağlamak, immünsupresif ilaçların kullanımı ve cerrahi yaklaşım tedavi için uygulanabilir. Bu makalede dokuz yıldır renal replasman tedavisi olarak sürekli ayaktan periton diyalizi kullanmakta olan, peritonit atakları, şiddetli karın ağrısı ve kilo kaybı semptomları ile başvuran ve sklerozan enkapsüle peritonit tanısı alan 46 yaşında erkek olgu sunulmaktadır.

Keywords

Sürekli ayaktan periton diyalizi bilgisayarlı batın tomografisi sklerozan enkapsüle peritonit

References

  • Chew MH, Sophian Hadi I, Chan G, Ong HS, Wong WK. A problem encapsulated: The rare peritoneal encapsulation syndrome. Singapore Med J 2006; 47: 808-10.
  • Xu P, Chen LH, Li YM. Idiopathic sclerosing encapsulating peritonitis (or abdominal cocoon): a report of 5 cases. World J Gastroenterol 2007; 13: 3649-51. Foo KT, Ng KC, Rauff A, Foong WC, Sinniah R. Unusual small intestinal obstruction in adolescent girls: the abdominal cocoon. Br J Surg 1978; 65: 427
  • Meng MV, Freise CE, Stoller ML. Sclerosing peritonitis. Urology 2003; 61: 1257Kim BS, Choi HY, Ryu DR, Yoo TH, Park HC, Kang SW, Choi KH, Ha SK, Han DS, Lee HY. Clinical characteristics of dialysis related sclerosing encapsulating peritonitis: multi-center experience in Korea. Yonsei Med J 2005; 46: 104-11.
  • Bozkurt D, Ertilav M, Duman S. Experimental Models of Sclerosing Peritonitis. Turkiye Klinikleri J Nephrol-Special Topics 2010; 3: 90-4.
  • Rigby R, Hawley CM. Sclerosing peritonitis: the experience in Australia. Nephrol Dial Transplant 1998; 13: 154-9.
  • Selgas R, Bajo A, Jiménez-Heffernan JA, Sánchez-Tomero JA, Del Peso G, Aguilera A, López-Cabrera M. Epithelial-to-mesenchymal transition of the mesothelial cell--its role in the response of the peritoneum to dialysis. Nephrol Dial Transplant 2006; 21 Suppl 2: 2-7.
  • Dobbie JW. Serositis: Comparative analysis of histological findings and pathogenetic mechanisms in nonbacterial serosal inflammation. Perit Dial Int 1993; 13: 256-9.
  • Cudazzo E, Lucchini A, Puviani PP, Dondi D, Binacchi S, Bianchi M, Franzini M. Sclerosing peritonitis. A complication of LeVeen peritoneovenous shunt. Minerva Chir 1999; 54: 809-12.
  • Stanley MM, Reyes CV, Greenlee HB, Nemchausky B, Reinhardt GF. Peritoneal fibrosis in cirrhotics treated with peritoneovenous shunting for ascites. An autopsy study with clinical correlations. Dig Dis Sci 1996; 41: 571-7.
  • Clement PB, Young RH, Hanna W, Scully RE. Sclerosing peritonitis associated with luteinized thecomas of the ovary. A clinicopathological analysis of six cases. Am J Surg Pathol 1994; 18: 1-13.
  • Chalasani R, Marella P. Sclerosing encapsulating peritonitis in a 47-year-old woman. Kidney International 2006; 70: 1673.
  • Faller B, Marichal JF, Brignon P. Local immunologic reactions induced by CAPD. Nephrologie 1989; 10 Suppl: 30-3.
  • Naiki Y, Maeda Y, Matsuo K, Yonekawa S, Sakaguchi M, Iwamoto I, Hasegawa H, Kanamaru A. Involvement of TGF-beta signal for peritoneal sclerosing in continuous ambulatory peritoneal dialysis. J Nephrol 2003; 16: 95-102.
  • George C, Al-Zwae K, Nair S, Cast JE. Computed tomography appearances of sclerosing encapsulating peritonitis. Clin Radiol 2007; 62: 732-7.
  • Kawaguchi Y, Kawanishi H, Mujais S, Topley N, Oreopoulos DG. Encapsulating peritoneal sclerosis: definition, etiology, diagnosis, and treatment. International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis. Perit Dial Int 2000; 20 Suppl 4: 43-55.
  • Stafford-Johnson DB, Wilson TE, Francis IR, Swartz R. CT Appearance of sclerosing peritonitis in patients on chronic ambulatory peritoneal dialysis. J Comput Assist Tomogr 1998; 22: 295-9.
  • Carcano G, Rovera F, Boni L, Dionigi G, Uccella L, Dionigi R. Idiopathic sclerosing encapsulating peritonitis: a case report. Chir Ital 2003; 55: 605-8.
  • Başaran C, Dönmez FY, Öztürk A, Tarhan NÇ, Sezer S, Coşkun M. Computerized tomography findings of sclerosing encapsulated peritonitis in the patients under CAPD treatment. Diyaliz Transplantasyon ve Yanık/Dialysis, Transplantation and Burns 2008; 19: 73-8.
  • Loughrey GJ, Hawnaur JM, Sambrook P. Case report: computed tomographic appearance of sclerosing peritonitis with gross peritoneal calcification. Clin Radiol 1997; 52: 557-8.
  • Nakamoto H. Encapsulating peritoneal sclerosis--a clinician's approach to diagnosis and medical treatment. Perit Dial Int 2005; 25 Suppl 4: 30-8.
  • Korzets A, Korzets Z, Peer G, Papo J, Stern D, Bernheim J, Blum M. Sclerosing peritonitis. Possible early diagnosis by computerized tomography of the abdomen. Am J Nephrol 1988; 8: 143-6.
  • Krestin GP, Kacl G, Hauser M, Keusch G, Burger HR, Hoffmann R. Imaging diagnosis of sclerosing peritonitis and relation of radiologic signs to the extent of the disease. Abdom Imaging 1995; 20: 414-20.
  • Cakir B, Kirbaş I, Cevik B, Ulu EM, Bayrak A, Coşkun M. Complications of continuous ambulatory peritoneal dialysis: evaluation with CT. Diagn Interv Radiol 2008; 14: 212-20.
There are 23 citations in total.

Details

Primary Language English
Journal Section Case Reports
Authors

Gürsel Yıldız

Abdulkerim Yılmaz

İbrahim Öztoprak

Ferhan Candan

Mansur Kayataş

Publication Date March 22, 2013
Published in Issue Year 2013Volume: 35 Issue: 1

Cite

AMA Yıldız G, Yılmaz A, Öztoprak İ, Candan F, Kayataş M. Sclerosing encapsulating peritonitis; silent danger in continuous ambulatory peritoneal dialysis patients: case report and review of the literature. CMJ. March 2013;35(1):113-119.