Hong Kong Journal of Nephrology

Volume 6 Number 2, 2004

Outcome of Sclerosing Peritonitis Complicating Peritoneal Dialysis

Calvin Y. Wong

Kin-Yee Lo
Siu-Ka Mak
Gensy M.W. Tong
Ping-Nam Wong
Andrew K.M. Wong

Renal Unit, Department of Medicine & Geriatrics, Kwong Wah Hospital, Kowloon, Hong Kong SAR, China.

Background: Sclerosing peritonitis (SP) is a rare but serious complication of peritoneal dialysis. Multiple causes have been implicated in its pathogenesis. Different approaches to management include conservative treatment, surgical intervention, and immunosuppressive therapy. We retrospectively reviewed the presentation and treatment outcome of seven patients with SP.
Methods: Overall, 552 patients underwent continuous ambulatory peritoneal dialysis (CAPD) between 1994 and 2003. Patients were included if there were suggestive clinical features and either radiologic or surgical evidence of SP. Seven patients developed SP, five men and two women, with a median age of 41 years (range, 32-64 years). The median duration of CAPD prior to development of SP was 72 months (range, 48-125 months). In six patients, SP occurred soon after an episode of CAPD-related peritonitis (range, 1-7 months).
Results: Patients presented with acute abdominal pain, ascites, small bowel intestinal obstruction, and failure of Tenckhoff catheter reinsertion. Abdominal X-ray, ultrasonography, and computed tomography scans were helpful in the diagnosis. Laparotomies were performed in six patients (typical cocoon appearance of peritoneum in three). No patients underwent adhesiolysis or received immunosuppressive therapy. All patients were switched to hemodialysis. Five patients required temporary total parenteral nutritional support. Four patients survived but none returned to CAPD. The other three patients died of sepsis.
Conclusion: SP is a serious complication of peritoneal dialysis with a mortality rate of 43%. Severe peritonitis, especially in patients on dialysis for longer than 4 years, is associated with development of SP. Prevention and optimal treatment of CAPD-related peritonitis might be important in preventing SP.

Key words: CAPD, sclerosing peritonitis

背景:硬化性腹膜炎 (SP) 是腹膜透析的一種罕見但嚴重的併發症,其出現相信與多種因素有關。 SP 的臨床處置方式包括保守療法、外科療法、及免疫抑制療法。以下就 7 SP 患者的臨床表現及對治療的反應作出報告。
方法:在 1994-2003 年期間,共有 552 位病人曾接受連續攜帶式腹膜透析( CAPD );其中 7 人( 5 2 女)出現 SP 的臨床表現兼影像學或病理學證據,年齡中位數為 41 (範圍 32-64 )歲, SP 被發現前的 CAPD 持續時間中位數為 72 (範圍 48-125 )個月。在其中 6 位病人中, SP CAPD 併發腹膜炎後不久出現(範圍 1-7 個月)。
結果:病人的表現包括急性腹痛、腹水、小腸阻塞、及 Tenckhoff 導管不能重新置放;有助於診斷的方法則包括腹部 X 光、超音波、及電腦斷層掃描。共 6 人接受剖腹術,其中 3 人的腹膜出現典型的繭狀變化。無病人接受黏連分割或免疫抑制療法,但所有病人均轉換至血液透析療法。 5 人需接受暫時性的全非經腸道營養。 4 人存活但並未恢復 CAPD ;其他 3 人則死於敗血症。
結論: SP 是腹膜透析的一種嚴重的併發症,死亡率高達 43% 。嚴重的腹膜炎,特別在持續接受透析多於 4 年的病人中,是 SP 的可能危險因子之一。一般認為, CAPD 相關腹膜炎的預防與妥善治療,是預防 SP 的可行途徑。

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