Evaluation of five patients on CAPD with sclerosing encapsulating peritonitis

Abstract

Sclerosing peritonitis or sclerosing encapsulating peritonitis (SEP) is one of the most serious complications in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). We experienced five SEP patients (3 males, 2 females) between 1980 and 1993. Their average age was 48 years, and ranged from 30 to 64 years. All of the patients were treated by hemodialysis and CAPD. Average duration on CAPD in these patients was 5 years.
All of the patients developed peritonitis between 1 and 8 times (average: 4 times) during CAPD treatment. Four patients required surgical intervention, including laparotomy in 3 cases and laparoscopic surgery in 1 case. Four patients died of septicemia, while two have been successfully treated with home parenteral hyperalimentation and self catheter drainage of gastrointestinal fluid for at least one year. Since there is no effective treatment available for advanced SEP, prevention and/or early detection are crucial. Our findings suggest that intensive nutrition therapy, including home parenteral hyperalimentation, may be beneficial in patients with advanced SEP. Although surgical intervention is still controversial because of significant perioperative mortality, the sac-like cocoon formations in the small intestine become foci of septicemia, which is often fatal in advanced SEP. Therefore, new surgical approaches, such as total resection of the small intestine followed by small bowel transplantation, should be considered.