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Yılmaz F, Bora F, Çetinkaya R, Gelen MT, Süleymanlar G, Ersoy F. A case of cyclic hemoperitoneum in a hemodialysis patient: Encapsulated peritoneal sclerosis complicated by endometriosis and fungal peritonitis. Semin Dial 2020; 34:176-179. [PMID: 33349976 DOI: 10.1111/sdi.12945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Encapsulated peritoneal sclerosis (EPS) is a rare, but frequently fatal, long-term complication of peritoneal dialysis. Endometriosis is a common gynecological problem but hemoperitoneum due to endometriosis has been reported to be extremely rare in hemodialysis (HD) patients. A 25-year-old female HD patient was admitted to our clinic with nausea, vomiting, abdominal pain, and weight loss for last 3 months. Candida tropicalis and Candida glabrata were isolated in the fungal cultures from peritoneal fluid. Her abdominal computerized tomography scan has shown irregular peritoneal calcifications, diffuse peritoneal thickening, dilatation of the small bowel loops, and cocoon formation which all were typical for EPS. Hemoperitoneum was reported to recur for four times with intervals suggesting menstrual cycles. Her peritoneal biopsy, along with the signs of EPS, has also revealed the presence of endometriosis. The patient died with symptoms of septic shock in the first year of EPS diagnosis.
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Affiliation(s)
- Fatih Yılmaz
- Department of Nephrology, Antalya Ataturk State Hospital, Antalya, Turkey
| | - Feyza Bora
- Division of Nephrology, Department of Internal Medicine, Akdeniz University Medical School, Antalya, Turkey
| | - Ramazan Çetinkaya
- Division of Nephrology, Department of Internal Medicine, Akdeniz University Medical School, Antalya, Turkey
| | | | - Gültekin Süleymanlar
- Division of Nephrology, Department of Internal Medicine, Akdeniz University Medical School, Antalya, Turkey
| | - Fevzi Ersoy
- Division of Nephrology, Department of Internal Medicine, Akdeniz University Medical School, Antalya, Turkey
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2
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Intra-abdominal Complications After Pediatric Kidney Transplantation: Incidence and Risk Factors. Transplantation 2019; 103:1234-1239. [DOI: 10.1097/tp.0000000000002420] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ghadimi M, Dashti-Khavidaki S, Khalili H. mTOR inhibitors for management of encapsulating peritoneal sclerosis: a review of literatures. Ren Fail 2016; 38:1574-1580. [DOI: 10.1080/0886022x.2016.1209026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Maryam Ghadimi
- Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Simin Dashti-Khavidaki
- Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Khalili
- Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Posttransplant encapsulating peritoneal sclerosis, long-term success with everolimus and low-dose CNI: a case report. Transplant Proc 2015; 46:2368-70. [PMID: 25242790 DOI: 10.1016/j.transproceed.2014.07.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Encapsulating peritoneal sclerosis is a serious complication of peritoneal dialysis and can occur even after transplant. The gut is partially or totally enveloped by a thick fibrous membrane that leads to the formation of multiple sections containing intestinal loops contracted and reduced in volume. Exacerbation after renal transplantation is a very rare but sometimes dramatic condition. We report a patient who developed intestinal obstruction due to encapsulating peritoneal sclerosis 1 year after a deceased-donor kidney transplant. Treatment included laparotomy, small-bowel lengthening by release of adhesions, and high doses of corticosteroids. The patient received immunosuppressive therapy with a combination of low-dose cyclosporine, everolimus, and prednisone, unchanged except for a temporary steroid increase in the postoperative period. We report success with this combined surgical plus medical therapy, with no recurrence after 81 months of follow-up.
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Messina M, Ariaudo C, Mella A, Cantaluppi V, Segoloni GP, Biancone L. mTOR inhibitors for medical treatment of post-transplantation encapsulating peritoneal sclerosis: a favourable single center experience. J Nephrol 2015; 28:245-9. [PMID: 25585825 DOI: 10.1007/s40620-014-0168-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 12/09/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Encapsulating peritoneal sclerosis (EPS) is a serious complication in patients on peritoneal dialysis (PD) causing intestinal obstruction. Two different forms of EPS are reported: the classical one observed in patients on PD, and post-transplantation EPS (PostTx-EPS). The first-line therapy of classical and PostTx-EPS remains surgical treatment, but for both the complication rate and mortality are high. Recently, a few cases of EPS were successfully treated with inhibitors of mammalian target of rapamycin (mTORi). The aim of this study was to evaluate PostTx-EPS outcome in our patients, focusing on the potential benefit of mTORi treatment. METHODS We performed a retrospective analysis on 1,048 kidney transplanted patients at our center between 11/2001 and 12/2011. RESULTS In the 226 patients treated with PD at any time before grafting, we found 10 cases of PostTx-EPS (prevalence 4.4%). The mean age was 54.9 years (26-69), with a mean time on PD of 83.1 months (33-156). The interval between kidney transplant and EPS diagnosis was 10.5 months (4-18.9). Five of the ten patients were treated after the diagnosis with mTORi, with a favorable outcome in 4/5 cases. This result was substantially independent of surgical and steroid therapy, performed in 9/10 and 10/10 patients respectively. CONCLUSION EPS is a serious complication but susceptible to improvement if early diagnosed. mTORi represent a useful option for EPS treatment. We too suggest adopting an immunosuppressive protocol based on mTORi, mycophenolate mofetil and steroids in order to prevent PostTx-EPS in transplanted patients at high risk.
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Affiliation(s)
- Maria Messina
- Renal Transplantation Unit "A. Vercellone", Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città della Salute e della Scienza Hospital and University of Torino, Corso Bramante, 88-10126, Turin, Italy,
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Stefanidis CJ, Shroff R. Encapsulating peritoneal sclerosis in children. Pediatr Nephrol 2014; 29:2093-103. [PMID: 24258273 DOI: 10.1007/s00467-013-2672-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 10/15/2013] [Accepted: 10/18/2013] [Indexed: 02/01/2023]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare but extremely serious complication of peritoneal dialysis (PD). While EPS has been well recognized in adults on long-term PD, and children can spend many years on PD before a transplant becomes available, only a small number of children with EPS have been described. Two European pediatric registries have recently reported on the prevalence, potential risk factors and outcomes of EPS in children. Although the prevalence of EPS is comparable to that published in adult registries, the outcome of pediatric EPS is significantly better and carries a lower mortality. All studies have shown a greater risk of EPS with a longer dialysis vintage, but it is not known why some individuals are susceptible to EPS development. In this review we discuss current views on the epidemiology, pathogenesis and management strategies for EPS. The hope of the authors is that this review will alert pediatric nephrologists to this rare but extremely serious complication of chronic PD. In the future, collaborative research and the establishment of a pediatric EPS registry may be of importance in helping pediatric nephrologists to recognize the early warning signs of EPS development and thereby to develop strategies for its prevention and optimal management.
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Affiliation(s)
- Constantinos J Stefanidis
- Department of Nephrology, "P. & A. Kyriakou" Children's Hospital of Athens, Thivon and Levadias Str, Goudi, 14562, Athens, Greece,
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Rumbo C, Zambernardi A, Cabanne A, Rumbo M, Gondolesi G. Sclerosing peritonitis, a rare complication after intestinal transplant. Report of one case successfully treated with adjustment of immunosuppression. Pediatr Transplant 2013; 17:E125-9. [PMID: 23902605 DOI: 10.1111/petr.12110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2013] [Indexed: 01/01/2023]
Abstract
Sclerosing peritonitis is a complication described in different clinical situations, such as patients that underwent prolonged peritoneal dialysis or renal transplantation with previous history of peritoneal dialysis. The origin of this entity is unclear so far and it is believed that several mechanisms may contribute to its development. The hallmark of sclerosing peritonitis is the continuous accumulation of fibrocollagenous deposits in the intestinal wall and mesenteries causing progressive adhesion of the intestinal loops and mesenteric retraction resulting in intestinal obstruction. Also, it has been described as a rare complication after intestinal transplant that might lead to graft failure. In this report, we describe a case of sclerosing peritonitis after intestinal transplantation that was successfully treated with modifications in the immunosuppressive regime allowing restitution of gastrointestinal transit and intestinal autonomy.
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Affiliation(s)
- Carolina Rumbo
- Instituto de Trasplante Multiorgánico (ITMO), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.
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Vidal E, Edefonti A, Puteo F, Chimenz R, Gianoglio B, Lavoratti G, Leozappa G, Maringhini S, Mencarelli F, Pecoraro C, Ratsch IM, Cannavò R, De Palo T, Testa S, Murer L, Verrina E. Encapsulating peritoneal sclerosis in paediatric peritoneal dialysis patients: the experience of the Italian Registry of Pediatric Chronic Dialysis. Nephrol Dial Transplant 2013; 28:1603-9. [DOI: 10.1093/ndt/gft061] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Enrico Vidal
- Pediatric Nephrology, Dialysis and Transplantation Unit, Department of Pediatrics, University of Padova, Padova, Italy
| | - Alberto Edefonti
- Pediatric Nephrology and Dialysis Unit, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, Milano, Italy
| | - Flora Puteo
- Nephrology Division, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Roberto Chimenz
- Department of Pediatrics, Nephrology Unit, University School of Medicine, Messina, Italy
| | - Bruno Gianoglio
- Nephrology, Dialysis and Transplantation Unit, Regina Margherita Children's Hospital, Torino, Italy
| | | | - Giovanna Leozappa
- Nephrology and Urology Department, Bambino Gesù Children's Hospital, Roma, Italy
| | - Silvio Maringhini
- Pediatric Nephrology Unit, Children's Hospital ‘G. Di Cristina’, A.R.N.A.S. ‘Civico’, Palermo, Italy
| | - Francesca Mencarelli
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - Carmine Pecoraro
- Nephrology and Dialysis Unit, Santobono Children's Hospital, Napoli, Italy
| | | | - Rossella Cannavò
- Dialysis Unit, Nephrology and Dialysis Division, IRCCS Giannina Gaslini, Genova, Italy
| | - Tommaso De Palo
- Nephrology Division, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Sara Testa
- Pediatric Nephrology and Dialysis Unit, Fondazione Ca’ Granda IRCCS Ospedale Maggiore Policlinico, Milano, Italy
| | - Luisa Murer
- Pediatric Nephrology, Dialysis and Transplantation Unit, Department of Pediatrics, University of Padova, Padova, Italy
| | - Enrico Verrina
- Dialysis Unit, Nephrology and Dialysis Division, IRCCS Giannina Gaslini, Genova, Italy
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Shroff R, Stefanidis CJ, Askiti V, Edefonti A, Testa S, Ekim M, Kavaz A, Ariceta G, Bakkaloglu S, Fischbach M, Klaus G, Zurowska A, Holtta T, Jankauskiene A, Vondrak K, Walle JV, Schmitt CP, Watson AR. Encapsulating peritoneal sclerosis in children on chronic PD: a survey from the European Paediatric Dialysis Working Group. Nephrol Dial Transplant 2013; 28:1908-14. [DOI: 10.1093/ndt/gfs603] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rukshana Shroff
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | | | | | - Sara Testa
- Clinica Pediatrica De Marchi, Milan, Italy
| | | | - Asli Kavaz
- Ankara University Hospital, Ankara, Turkey
| | | | | | | | | | | | | | | | | | | | | | - Alan R. Watson
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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