Abstract

VIEIRA, Miguel Bigotte; PEREIRA, Marta  and  PINTO DE ABREU, Cristina. Intestinal obstruction in a patient on chronic hemodialysis. Port J Nephrol Hypert [online]. 2018, vol.32, n.3, pp.293-298. ISSN 0872-0169.

Encapsulating peritoneal sclerosis (EPS) is an uncommon but serious complication of peritoneal dialysis (PD). We present a case report of EPS and a brief description of the disease. A previously stable 47-year-old male patient on hemodialysis (HD) presented to the hospital with weight loss, fever, anorexia, increased abdominal volume, anemia, increased inflammatory markers, septated hemoperitoneum, and peritoneal thickening on imaging. The patient had previously been on PD for 8 years and had 7 peritonitis episodes caused by different microorganisms. Note that the patient had a previous history of multiple vascular access failure and presented poor habitational conditions and socioeconomic status. He had been transferred from PD to HD five months earlier due to hypervolemia. A diagnosis of EPS was considered. Treatment was initiated with regular peritoneal lavage, nutritional support, oral prednisolone, and tamoxifen. The patient presented complete resolution of the symptoms and regularization of inflammatory markers. Two months later he presented to the emergency room with intestinal obstruction, and surgical enterolysis with debridement of the thick cocoon of fibrous tissue was performed. However, the patient presented several complications and died two months after admission. In conclusion, a high index of clinical suspicion of EPS in susceptible patients is necessary as the disease is infrequent and may be fatal. A greater awareness of EPS may lead to earlier or increased diagnosis rates in milder cases. This case report highlights the importance of implementing preventive measures in patients with several risk factors for EPS and considering an EPS diagnosis in a patient that is no longer on PD

Keywords : Encapsulating peritoneal sclerosis; peritoneal dialysis; peritoneal fibrosis.

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