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Sclerosing peritonitis with gross peritoneal calcification: a case report.
1Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Summary
A patient on long-term continuous ambulatory peritoneal dialysis (CAPD) developed severe sclerosing peritonitis with extensive peritoneal calcification. Early imaging is crucial for detecting this rare complication in dialysis patients with persistent bowel issues.
Area of Science:
- Nephrology
- Gastroenterology
- Radiology
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a common treatment for end-stage renal disease.
- Long-term CAPD can be associated with complications, including peritoneal membrane dysfunction.
- Sclerosing peritonitis is a rare but serious complication affecting the peritoneum.
Observation:
- A patient on CAPD for 11 years developed sclerosing peritonitis with extensive peritoneal calcification.
- Peritoneal calcification was detected via X-ray and CT scan before significant ultrafiltration impairment or symptoms.
- The patient experienced abdominal pain, acute peritonitis, and persistent adynamic ileus, ultimately leading to bowel infarction and death.
Findings:
- This case presented with extensive peritoneal calcification and sclerosing peritonitis, exceeding previously reported instances.
- Unlike other cases, this was not linked to frequent peritonitis, acetate dialysate, calciphylaxis, or calcium-phosphate abnormalities.
- Peritoneal calcification was noted on imaging while the patient was largely asymptomatic.
Implications:
- Early abdominal X-ray or CT scanning is recommended for long-term CAPD patients with recurrent or persistent bowel symptoms.
- Detection of sclerosing peritonitis or bowel calcification may warrant transfer to alternative dialysis modalities.
- This case highlights the importance of vigilant monitoring and diagnostic imaging in CAPD patients.