Abstract: SA-PO0385
Persistent Abscess in a Patient with Encapsulating Peritoneal Sclerosis: A Rare and Fatal Complication
Session Information
- Home Dialysis: Science and Cases, from Lab to Living Room
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Duong, Vien Duc, Nephrology and Hemodialysis Deparment, University Medical Center, Ho Chi Minh City, Viet Nam
- Dang, Vi Tuong, Nephrology and Hemodialysis Deparment, University Medical Center, Ho Chi Minh City, Viet Nam
- Le, Cong Chi, Nephrology and Hemodialysis Deparment, University Medical Center, Ho Chi Minh City, Viet Nam
- Huynh, Thao Ngoc Phuong, Nephrology and Hemodialysis Deparment, University Medical Center, Ho Chi Minh City, Viet Nam
Introduction
Encapsulating peritoneal sclerosis (EPS) is a rare, life-threatening complication of long-term peritoneal dialysis (PD). We report a case of persistent peritoneal abscess following catheter removal due to refractory peritonitis.
Case Description
A 17-year-old male with history of Wilms' tumor and bilateral nephrectomy at age 2, had been on PD for 15 years without prior peritonitis. He developed EPS with multiple episodes of partial bowel obstruction; however, due to the unavailability of peritonectomy in Vietnam and the family’s wishes, PD was continued. After developing treatment-resistant C. difficile peritonitis that led to catheter removal and hemodialysis transition, he returned one month later with fever, abdominal pain, and distension. Paracentesis yielded turbid fluid with 158,788 WBC/mm3 (85% neutrophils) and procalcitonin of 2.73 ng/mL. Abdominal ultrasound showed substantial echogenic peritoneal fluid. CT scan revealed diffuse peritoneal calcification, and significant fluid collection in the left subphrenic space and right iliac fossa. Despite two weeks of Imipenem/Cilastatin and Vancomycin therapy, the patient's condition deteriorated with fever and rapid turbid fluid reaccumulation. This necessitated surgical placement of two pigtail catheters into the peritoneal cavities for continuous irrigation and drainage. After 3 weeks of continuous irrigation via pigtail catheters, drainage fluid gradually decreased to approximately 30 ml of clear yellow fluid daily. Follow-up CT scan confirmed significant improvement in peritoneal fluid collections. The drainage tubes were subsequently removed, and the patient was discharged one week later.
Discussion
Residual abscess in EPS patients is rare but potentially fatal. Antibiotic efficacy is limited by peritoneal fibrosis and loculated compartments. This case demonstrates that surgical drainage with continuous irrigation can be effective when antibiotics alone fail.
CT findings