ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-PO736

Sclerosing Encapsulating Peritonitis Developing Two Years after Peritoneal Dialysis Cessation

Session Information

  • Peritoneal Dialysis - II
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Author

  • Maditz, Rhyan, Beaumont Health - Royal Oak, Royal Oak, Michigan, United States
Background

Sclerosing encapsulating peritonitis (SEP) is a rare chronic inflammatory condition of the peritoneum believed to result from recurrent low grade peritonitis. The condition occurs when loops of bowel are encased within the peritoneal cavity by a membrane, leading to intestinal obstruction. Long peritoneal dialysis (PD) duration, acetate-buffered or hypertonic solutions and recurrent episodes of peritonitis may contribute to the development of SEP.

Methods

46 yo male with PMHx of ESRD secondary to FSGS and loculated sclerosing peritonitis presented with fatigue of one-week duration. He was previously on PD for years but switched to HD two years prior to presentation because he was unable to achieve adequate clearance. He missed two HD sessions prior to arrival due to fatigue. CT performed on admission revealed a large amount of complicated/complex ascites, thickening of the peritoneum and nonspecific colitis and enteritis. Soon after admission, the patient became altered, hypotensive, and was transferred to the medical intensive care unit. Patient was anorexic during the hospitalization, unable to tolerate oral intake. PEG tube insertion was determined to be too risky given his comorbidities and a dobhoff tube was inserted. Methylprednisolone 500 mg daily for three days was trialed, which did not lead to clinical improvement. Further immunosuppression with Imuran/calcineurin inhibitors was determined to be too high risk. Enterolysis was discussed, however, patient was deemed too high risk for surgery given his debilitated state. Despite the best efforts of a corroboration of medical specialties, the patient unfortunately expired after a one-month hospital stay.

Conclusion

Clinicians must be aware of SEP as a rare, but dangerous complication of prolonged PD. Patients with SEP secondary to PD progress rapidly and treatment should be immediately initiated after diagnosis. Our patient may have benefited from total parenteral nutrition (TPN), however volume status is difficult to control after TPN initiation. The patient was trialed on a short course of Solumedrol without success. Enterolysis, a last resort treatment modality for SEP, is reported to improve outcomes. Our patient was a poor surgical candidate and likely would have not survived the procedure; therefore, enterolysis was not attempted. Earlier recognition of SEP may have resulted in a better outcome for our patient.