Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021843 (bowel obstruction)
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Sclerosing peritonitis (SP) is an uncommon but serious complication of CAPD with various suggested etiologies. We have documented 14 cases of SP in 18 patients who had used chlorhexidine in alcohol (ChA) in the connection procedure for CAPD. Thirteen died. Nine of the 14 patients had been transferred to hemodialysis or renal transplantation, yet all still developed symptoms of SP within a few months after transfer - even the 5 who were originally asymptomatic. The main symptoms of SP were peritoneal ultrafiltration failure, exudative bloody ascites and intestinal obstruction. They presented at around 5 years (30-80 months) after commencement of CAPD. Most deaths were related to intestinal obstruction. Four other patients with a comparable duration of ChA exposure were continued on CAPD with the Travenol Spike System (TSS), without further exposure to ChA. They were all asymptomatic of SP after 9-12 months. Comparing the 2 groups of asymptomatic patients, those transferred to TSS had a much better outcome after 9 months than those transferred to HD or renal transplantation (P = 0.0476). We suggest that ChA is the main cause of SP in our patients and that continuing CAPD without further exposure to ChA is a better alternative than stopping CAPD to prevent the progression of SP.
Perit Dial Int 1991
PMID:Sclerosing peritonitis complicating prolonged use of chlorhexidine in alcohol in the connection procedure for continuous ambulatory peritoneal dialysis. 151 Oct 54

Twelve children with end stage renal disease requiring dialysis received enteral feedings via nasogastric (NG) or gastrostomy (G) tube between 1984 and 1989 for provision of adequate nutrition. Records were reviewed for frequency and types of complications seen. Six patients, ages 1 week to 16 months received NG feedings for a total of 32 months. Complications included persistent vomiting with recurrent aspiration (2), persistent vomiting with peritoneal dialysis (PD) exit site leak (1), sinusitis (1), and refusal to continue NG feeds because of patient/parental anxiety (1). Three of the 6 were changed to G tube feedings after 2 days to 3 months. The complication rate was 1 per 6.4 patient months. Nine patients, ages 4 days to 11 years, received G tube feedings for 64 months. The complication rate was similar, 1 per 7.1 months. Complications were PD fluid leak around G tube exit site (1), G tube infection (2), G tube obstruction requiring tube replacement (3), tube migration producing intestinal obstruction (1), and gastrocutaneous fistula (2). Both methods were associated with similar complication rates, although somewhat different types of complications were seen. The young dialysis patient may have certain unique risks in addition to the complications generally associated with enteral feedings.
Adv Perit Dial 1990
PMID:Complications of nasogastric and gastrostomy tube feedings in children with end stage renal disease. 198 21

Sclerosing peritonitis (SP) is an uncommon but serious complication of CAPD with various suggested etiology. We have documented 14 cases of SP in 18 CAPD patients using chlorhexidine in alcohol (ChA) in the connection procedure; 13 died. Nine of the 14 patients had been transferred to haemodialysis or renal transplantation, yet all still developed symptoms of SP within a few months after transfer even though 5 of them were originally asymptomatic. The main symptoms of SP were peritoneal ultrafiltration failure, exudative bloody ascites and intestinal obstruction. They present at around 5 years (30-80 months) after commencement of CAPD. Four other patients with a comparable duration of ChA exposure were continued on CAPD with a Travenol Spike System (TSS) without further exposure to ChA. They were all asymptomatic of SP after 9-12 months. Comparing the 2 groups of asymptomatic patients at 9 months after transfer, those transferred to TSS have a much better outcome than those transferred to HD or renal transplantation (P = 0.0476). We concluded that ChA is the main cause of SP in our patients and continuing CAPD without further exposure to ChA is a better alternative than stopping CAPD in preventing the progression of SP.
Adv Perit Dial 1990
PMID:Sclerosing peritonitis complicating continuous ambulatory peritoneal dialysis with the use of chlorhexidine in alcohol. 198 46

Sclerosing peritonitis (ScP) is a rare but fatal complication of continuous ambulatory peritoneal dialysis (CAPD), presenting as small bowel obstruction. We have observed that only patients receiving a renal transplant survived more than a few months after the diagnosis of ScP. We now report prolonged survival of patients given immunosuppressive therapy with or without a functioning transplant. ScP was found at laparotomy in 17 Glasgow patients, 15 of whom had been exposed to chlorhexidine in alcohol. All patients discontinued CAPD after diagnosis. Within a year 12 died with recurrent bowel obstruction; none received immunosuppressive therapy. The remaining 5 patients received immunosuppressive therapy; 4 are alive between 1 and 9 years later, and one patient with widespread vascular disease died after 3 years with mesenteric ischemia. Four of the 5 received a renal transplant. One patient rejected his transplant; when immunosuppression was stopped he developed symptoms suggestive of recurrent ScP. Immunosuppressive therapy was restarted and he remains well 3 years later. The fifth patient, who did not receive a transplant, was immunosuppressed after ScP was diagnosed. She remains well 18 months later. Our experience suggests that immunosuppression is beneficial in ScP.
Adv Perit Dial 1993
PMID:Immunosuppression in sclerosing peritonitis. 810 20

beta 2-M amyloidosis mainly concerns dialysis patients and typically presents with osteoarticular symptoms. In order to precise the incidence and gravity of visceral involvement, subcutaneous abdominal fat aspirates, skin and rectal biopsies, as well as echocardiograms were performed in 26 patients with severe beta 2-M amyloidosis. Visceral amyloidosis was confirmed in 58% and the numbers were even higher when including heart abnormalities suggestive of amyloidosis (81%). Clinical manifestations of visceral involvement were usually not severe and include odynophagia, gastrointestinal haemorrhage, intestinal obstruction, kidney stones, myocardial dysfunction and subcutaneous tumours. The removal and synthesis rates of beta 2-M were assessed during dialysis. Serum 131I-beta 2-M levels decreased by 5-10% with cuprophane and by 40-45% with polysulfone and polyacrylonitrile membranes. These reduction rates were higher than those found with unlabelled beta 2-M suggesting an increased synthesis or release during dialysis. The protein constituents of amyloid deposits were studied. Two different preparative methods to extract the proteins from amyloid deposits were used. TCA precipitation showed the presence of several proteins which were not observed with PBS homogenizing and resuspending in guanidine. The protein constituents of amyloid fibrils were studied by both, two dimensional gel electrophoresis (2D-gel) as well as protein sequencing after gel filtration. Similarly, the technical approach used for protein analysis greatly influenced the results. It was observed that 2D-gel displayed the presence of proteins which were missed by the gel filtration technique. Some of the proteins contained in amyloid deposits in addition to beta 2-M, were identified as globin chains, kappa and lambda light chains of immunoglobulins, and alpha 2 macroglobulin. A putative participation of these other protein constituents on the pathogenesis of beta 2-microglobulin amyloidosis is discussed.
Nephrol Dial Transplant 1996
PMID:Dialysis-related amyloidosis: visceral involvement and protein constituents. 884 Mar 30

A variable degree of diffuse peritoneal fibrosis has been documented in all patients who have been on long-term peritoneal dialysis. Peritoneal dialysis-induced diffuse peritoneal fibrosis varies from opacification and "tanning" of the peritoneum, which may have only a moderate detrimental effect on peritoneal transport kinetics, to a progressive, sclerosing encapsulating peritonitis (SEP), which may lead to cessation of peritoneal dialysis and to death. Fewer than 1% of peritoneal dialysis patients develop overt SEP as manifested by combinations of intestinal obstruction, weight loss, and ultrafiltration failure. The diagnosis of SEP depends on a combination of laparotomy and radiological features in suspected cases and consequently the true incidence of SEP is most likely underestimated. Several predisposing, interrelated risk factors for both peritoneal fibrosis and sclerosing encapsulating peritonitis have been identified: prolonged duration of peritoneal dialysis, history of severe or recurrent episodes of peritonitis, and higher exposure to hypertonic glucose-based dialysis solutions. Nevertheless, the etiology of SEP is unknown and several causal factors may simultaneously or sequentially initiate and maintain a low-grade serositis that leads to uncontrolled fibroneogenesis. The high mortality rate of SEP has emphasized the need to develop preventive strategies. These strategies include early peritoneal catheter removal to avoid refractory peritonitis, the development of more biocompatible dialysis solutions, restriction of the use of hypertonic glucose-based dialysis solutions during and after episodes of peritonitis, and, perhaps, limiting the duration of peritoneal dialysis in at-risk patients. This approach was followed in a Japanese unit where a subgroup of all patients who had been on peritoneal dialysis for more than 5 years and who had poor ultrafiltration and peritoneal calcification on computed tomography (CT) scan were shown to have peritoneal sclerosis on peritoneal biopsy and were therefore electively transferred to hemodialysis. This acquired spectrum of peritoneal fibrosing syndromes leads to long-term complications in peritoneal dialysis, whereas localized fibrous adhesions secondary to prior abdominal surgery may prevent the successful initiation of peritoneal dialysis.
Adv Perit Dial 2000
PMID:The spectrum of peritoneal fibrosing syndromes in peritoneal dialysis. 1104 99

Sclerosing encapsulating peritonitis (SEP) is a serious complication of peritoneal dialysis (PD). Previous reports place the prevalence of SEP at 0.54%-7.3%. We estimated the prevalence of SEP in our unit to be 1.4% over the period 1989-1999. We here present the 6 identified cases. All of the patients presented with small-bowel obstruction; hemorrhagic ascites was identified in 3 cases. All 6 patients experienced ultrafiltration inadequacy, and 5 were treated with glucose polymer (icodextrin; duration of treatment: 1 month-2.5 years). Peritoneal dialysis was stopped at the time of diagnosis in 2 cases. In the other 4 cases, PD had been withdrawn some time prior to the SEP being diagnosed (2 weeks-5 years). Five of the patients have died; the 6th currently uses hemodialysis.
Adv Perit Dial 2001
PMID:Sclerosing encapsulating peritonitis: a case series from a single U.K. center during a 10-year period. 1151 Feb 72

The principal complications of continuous ambulatory peritoneal dialysis (CAPD), namely malposition of the dialysis catheter, peritonitis, exit site infection, leakage of dialysis fluid, sclerosing peritonitis, and renal cysts and tumors, are considered in this article. The techniques that are used to reposition displaced dialysis catheters and extend the duration of dialysis are described. The role of imaging in establishing the diagnosis of peritonitis is relatively small. However, both computed tomography (CT) and ultrasound may be used to identify loculation of fluid and localized sites of sepsis, and permit percutaneous drainage. Ultrasonography of the catheter track through the percutaneous tissues allows identification of pericatheter collections in patients with exit-site infection. The technique of CT peritoneography is helpful in establishing sites of dialysis fluid leakage. These commonly occur at the site of entry of the dialysis catheter, through abdominal incisions, or along the patent tunica vaginalis into the scrotum. The appearances on CT of sclerosing peritonitis reflect pathologic changes and are characterized by the presence of peritoneal thickening and calcification. Bowel obstruction, which may develop in sclerosing peritonitis, can be identified on abdominal radiographs or barium studies of the gastrointestinal tract. Acquired renal cystic disease and renal carcinomas occur in a significant proportion of patients undergoing CAPD. Ultrasound is the investigation of first choice in the identification and clarification of the pathology (cystic or solid) of suspected renal masses.
Semin Dial
PMID:Image-guided peritoneal access and management of complications in peritoneal dialysis. 1219 Oct 25

Hernias can lead to significant morbidity in patients on peritoneal dialysis (PD). We studied the natural history and outcome of incarcerated hernia (IH), with or without bowel strangulation (IHS), in PD patients. We performed a retrospective chart review on all PD patients who developed an IH (n = 11) or an IHS (7/11) in the last 12 years. Of the 11 patients, 54% were female. The age range was 36 - 86 years (median: 61 years). Seven patients had a known history of a hernia that went on to become the index hernia that incarcerated with or without strangulation. The hernia types were umbilical (n = 8), inguinal (n = 2), and incisional in the area of the PD catheter (n = 1). Clinical presentations included painless abdominal mass (2 patients); tender and painful abdominal mass (4 patients); and abdominal pain, tenderness, and bowel obstruction (5 patients). Nine hernias were treated surgically--5 of them emergently for bowel ischemia. The other 4 patients who had incarcerated, non strangulated hernias were operated electively. One patient with IHS had the hernia manually reduced, and 1 patient with IHS had the hernia manually reduced and subsequently operated electively. Three patients with IHS and 2 with IH required temporary hemodialysis for between 4 days and 21 days. In PD patients, IHs are most commonly umbilical and have a propensity to strangulate. Patients treated operatively have an excellent prognosis and are usually able to continue PD. Abdominal wall hernias should be referred early to minimize mechanical complications.
Adv Perit Dial 2004
PMID:Natural history and outcome of incarcerated abdominal hernias in peritoneal dialysis patients. 1538 2

Encapsulating peritoneal sclerosis (EPS) is recognized as a serious complication of continuous peritoneal dialysis. A preliminary diagnosis of EPSis usually based on clinical signs and symptoms, which commonly include abdominal pain, nausea, vomiting, anorexia, abdominal fullness, an abdominal mass, bowel obstruction, and radiologic findings, including abdominal roentgenogram, contrast studies, ultrasound studies, and computed tomography. The diagnosis is confirmed by laparoscopy or laparotomy showing the characteristic gross thickening of the peritoneum enclosing some or all of the small intestine in a cocoon of opaque tissue. A variety of therapeutic approaches to EPS have been reported. This review discusses medical treatment of EPS and includes an overview of the clinical features and diagnostic aspects of the condition.
Perit Dial Int 2005 Apr
PMID:Encapsulating peritoneal sclerosis--a clinician's approach to diagnosis and medical treatment. 1630 Feb 70


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