A case of encapsulating peritoneal sclerosis developing 5 years after the cessation of peritoneal dialysis associated with calcification in the terminal ileum

Abstract

A 56-year-old man with end-stage kidney disease caused by IgA nephropathy started peritoneal dialysis (PD) in March 1992. He had four episodes of bacterial peritonitis during 11 years of PD treatment. At the 4th episode of persistent peritonitis in 2003, he was switched to hemodialysis (HD). After the cessation of PD, he was hospitalized six times due to abdominal pain and bowel obstruction from 2003 to 2009. Calcification of the peritoneum in the pelvis developed after the cessation of PD. Since encapsulating peritoneal sclerosis (EPS) findings such as ascites, peritoneal thickening, or abdominal cocoon were not observed on abdominal CT, he was diagnosed with adhesive intestinal obstruction. In 2010, he showed symptoms of ileus five times, but they were promptly resolved by fasting and decompression with an ileus tube. Because these episodes occurred frequently, surgery was performed in February 2011. During the operation, serious diffuse adhesion in the peritoneal cavity and local encapsulated small intestine and bowel calcified adhesion in the pelvic cavity were observed. He underwent synechiotomy and partial intestinal resection. He has been free from the symptoms for 10 months after surgery. In this patient, EPS might have developed due to pelvic calcification without an obvious inflammatory phase. It is important to observe patients carefully to avoid the development of peritoneal injury even after the cessation of PD.