Sclerosing peritonitis: identification of diagnostic, clinical, and radiological features

Sclerosing peritonitis is a rare, but serious complication of peritoneal dialysis. To attempt the early identification of patients at risk of developing this life-threatening problem, we performed a cross-sectional study of 15 patients: five had died of sclerosing peritonitis, four had stopped peritoneal dialysis because sclerosing peritonitis was suspected, and six were considered to be at increased risk because of more than 4 years on peritoneal dialysis. We examined the duration of dialysis, number of episodes of peritonitis, strength of peritoneal dialysis bags, the type of dialysate, and the use of beta blockers. We also used a number of radiologic investigations, including abdominal x-ray, a measure of colonic transit using radiopaque markers, abdominal ultrasound, and computed tomography scanning. Of the clinical features, only duration of dialysis could be shown to be an important risk factor. We identified a number of radiologic features that we believe to be early signs of peritoneal sclerosis. The two computed tomography scans that were available from the deceased patients demonstrated peritoneal thickening, as did those from three of the four living patients who stopped peritoneal dialysis with suspected disease and from two of the six patients who had been on peritoneal dialysis for over 4 years. Ultrasound demonstrated a characteristic trilaminar appearance in four patients, but was unable to be demonstrated without peritoneal fluid in situ. Delayed colon transit was demonstrated in three of the four living patients with clinically suspected disease. Radiologic screening to detect sclerosing peritonitis early in high-risk patients requires further study.