Encapsulating Peritoneal Sclerosis in Patients on Peritoneal Dialysis in Slovenia

Primary sclerosing encapsulating peritonitis: a case report

BACKGROUND

Sclerosing encapsulating peritonitis is a rare condition with a typical macroscopic appearance, with fibrocollagenous membrane enclosing loops of the small intestine, causing intestinal obstruction. Unexplained recurrent abdominal pain, obstruction, and a large array of other possible clinical signs and symptoms make sclerosing encapsulating peritonitis a diagnostic challenge.

CASE PRESENTATION

A 48-year-old man of Persian ethnicity was admitted multiple times to the emergency surgery department due to recurrent sudden abdominal pain and chronic obstruction without significant findings in medical history or clinical evaluation. Computed tomography was positive for proximal jejunal dilatation and duodenojejunal flexure stenosis due to internal mesenteric hernia. Exploratory laparoscopy, followed by laparotomy, confirmed thick membrane-like fibrous tissue with complete small intestinal loop envelopment. Extensive membrane excision and adhesiolysis was performed, but no mesenteric herniation was found. Early postoperative paralytic ileus with introduction of low-dose steroid therapy, based on histopathological and immunological results, confirming type III sclerosing encapsulating peritonitis, was completely resolved.

CONCLUSION

Sclerosing encapsulating peritonitis is a rare and difficult-to-diagnose condition, further divided into primary and secondary sclerosing encapsulating peritonitis, on the basis of underlying etiology, dictating treatment modality and prognosis. Intraoperative diagnosis and surgical treatment are mandatory, besides a wide variety of abdominal computed tomography scans, inconclusive results, and clinical presentations. There are so far no known specific markers for the diagnosis of sclerosing encapsulating peritonitis.

Encapsulating Peritoneal Sclerosis in Long-Termed Peritoneal Dialysis Patients

Background

Encapsulating peritoneal sclerosis (EPS) is a rare but serious clinical complication of long-term peritoneal dialysis (PD) patients with high mortality. The purpose of this study was to assess the clinical characteristics of patients with EPS and to search for possible factors useful for EPS prevention and early diagnosis.

Method

This retrospective study was performed in a single dialysis center in Taiwan between August 1990 and April 2014. Overall, a total of 565 patients were included and the medical records of those patients who had developed EPS (EPS group) and those who had not developed EPS (control group) were collected. We compared several factors between these two groups.

Result

In the univariate analysis, EPS was significantly associated with a change of transport state (Delta 2) (p = 0.007), duration of PD (p < 0.001), duration of peritonitis treatment (p = 0.001), number of peritonitis episodes (p = 0.002), and fungus related peritonitis (p = 0.031). After multivariate logistic model analysis, we found that only the duration of PD was independently significantly associated with EPS (p = 0.034). In addition, we used the ROC curve and found that a duration of peritoneal dialysis of about 8.4 years is the best cut-off point to predict EPS occurrence.

Conclusion

In this study, long-termed PD duration is the only strong independent risk factor for EPS development. Total peritonitis times, total peritonitis treatment duration, and marked increased peritoneal D/P_cr ratio were also significantly associated with the duration of PD.

Risk factors of severe peritoneal sclerosis in chronic peritoneal dialysis patients

Peritoneal dialysis (PD) offers the healthiest way for starting renal replacement therapy (RRT) in End Stage Renal Disease patients, however exposes long-term PD patients to a dangerous complication named encapsulating peritoneal sclerosis (EPS). In this study, we searched for possible risk factors of EPS. Data were collected from two PD centers covering period 1995-2012 and comprised 464 patients. Control group defined as PD patients stayed on PD >42 month (n = 122), and case group was 12 confirmed EPS patients. Associations were analyzed using linear regression analysis. Prevalence and incidence of EPS were 2.59% and 8.9% with an incidence of 0.7% patient-years, respectively. The age at start of PD in EPS patients (32.75 ± 10.8 year) was significantly lower compared with control group (49.61 ± 16.18 year, p = .0001). The mean duration of PD in EPS and control group were 2494.4 ± 940.9 and 1890.2 ± 598.8 days (p = .002). Control group had 145 episodes of peritonitis during total duration of 7686 patient months (peritonitis rate of 1/53). This was 1/26 with a total 38 episodes of peritonitis during the total duration of 997 patient months (p = .01) for EPS group. In regression analysis, PD duration, age at PD start and duration of Ultrafiltration failure (UFF) were associated with EPS. Longer time being on PD, younger age, and higher UFF duration were the risk factors for EPS development.