Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare complication of continuous ambulatory peritoneal dialysis (CAPD), presenting as abdominal pain, impaired ultrfiltrtion and repetitive intestinal obstruction. We report 2 patients with SEP diagnosed by abdominal ultrasound and computerized tomorphy (CT) who showed a marked improvement with steroid and immunosuppressive agents. Case 1: A 7-year-old woman with endstage diabetic nephropathy began CAPD therapy on June 1983. Because of poor drainage of peritoneal fluid, the treatment was changed to hemodialyis (HD) on November 1991. On May 1993, she complained of abdomial pain and body weight loss. The abdomen was distended and diffusely hard and was diagnosed as having SEP by abdominal ultrasound and CT. Prednisolone (5m/day) and cyclophosphamide (50m/day) were started and the intestinal obstruction improved. Case 2: A 7-year-old man with end-stage diabetic nephropathy began CAPD therapy on January 1994. On April, signs of peritonitis developed and tapylococcus epidermidis was isolated from his peritoneal fluid. On May, the treatment was changed to HD after only 4-month treatment of CAPD. On September 1994, he complained of nausea, vomiting and constipation. Abdominal CT scan revealed thickened peritoneum and the localized massive ascites. Prednisolone was started at a dose of 20mg in combination with cyclophosphamide of 50mg per day. No further symptoms related to SEP recurred after the combined treatment renisolon and with cyclophosphamide and T and ultrasound findings considerably improved. SEP has been recognized as fatal complication of CAPD, even after a cessation of CAPD, which needs total parenteral nutrition and surgical resection. Corticoteroid and immunosuppressive therapy with careful management of infections is suggested to be effective for SEP.
