Sclerosing Encapsulating Peritonitis Occurring after Very-Short-Term Intermittent Peritoneal Dialysis

Shinji Mutoh, MD, Department of Urology, Kumamoto University Medical School, 1-1-1 Honjo, Kumamoto City, 860 (Japan) Dear Sir, We experienced a case of sclerosing encapsulating peritonitis (SEP) which is a serious but rare complication of continuous ambulatory peritoneal dialysis (CAPD) and intermittent peritoneal dialysis (IPD). The patient who had been on hemodialysis for 12 years because of chronic renal failure, showed the symptoms and surgical findings of SEP. About l1⁄2 years before the diagnosis of SEP, the patient had been temporarily treated for 10 days with seven courses of IPD instead of hemodialysis because of tarry stool caused by relapsed duodenal ulcer. We could not elucidate the reason why peritoneal fibro-sis continued even after the cessation of IPD therapy. A 50-year-old patient who had been on hemodialysis for 12 years from August 1976, complained of nausea, vomiting and weight loss and was hospitalized in November, 1987. The patient had been operated on for duodenal ulcer in 1957 but no abnormal findings were found in the upper gastrointestinal tract. CT and ultrasonic examination showed as-cites. At colon examination by barium enema, compression narrowing was revealed 30 cm above the anus. An abdominal paracentesis showed bloody ascites but cytologic studies were negative for malignant cells. Pseudo-myxoma peritonei was suspected and laparotomy was done. Abdominal viscera stuck to each other forming a firm encapsulated bowel loop covered by thick fibrous tissue. Adheoly-sis of the bowel loop was difficult to perform and only surgical specimens were taken for histological examination. The diagnosis of sclerosing encapsulating peritonitis was Fig. 1. Histologic ■ . ■■ ‘•• examination of peri· toneum extirpated by ‚ · laparotomy. Proliferation of fibroconnec-tive tissue and fibrin deposits are recognized. HE. × 70. made (fig. 1). In March 1986, about l1⁄2 years before the operation, the patient had received very-short-term IPD therapy consisting of 7 courses during 10 days because tarry stool had