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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sclerosing peritonitis (SP) is a severe life-threatening condition for patients undergoing continuous ambulatory peritoneal dialysis (CAPD). This report reviews our experience and that reported in the literature concerning the prevalence of SP in CAPD patients, predisposing factors, and in particular, the role of peritonitis, its clinical presentation, diagnosis, treatment, and prevention. A total of 1,288 end-stage renal disease (ESRD) patients entered our peritoneal dialysis (PD) program between September 1977 and September 1997, seven of whom (0.54%) developed SP. The annual incidence of SP was 0.37 per 1,000 patient years, male-to-female ratio was 2.5 (M/F:5/2), mean age was 39+/-16 (median, 37; range, 23 to 61) years, and the median duration on CAPD was 62 (range, 12 to 144) months. Five patients were on CAPD for > or =4 years and two for less than 4 years before they were diagnosed with SP. All SP patients presented with clinical symptoms suggestive of intestinal obstruction, and five patients had decreased solute or fluid removal and had to increase the daily dialysate volume (3/7) or the tonicity of the fluid (4.25%) (3/7) or to combine a regular hemodialysis (HD) session with CAPD (2/7). There was a mean weight loss of 5+/-6 (median, 2; range, 0 to 18) kg. All patients had an episode of peritonitis at a mean time of 2+/-1 (median, 1; range, 1 to 3) months before the diagnosis of SP. The peritonitis was due to Staphylococcus aureus in four and Staphylococcus epidermidis, fungi, and Escherichia coli in one each. The definitive diagnosis of SP was established by laparotomy in four patients or postmortem examination in one patient, while in the remaining two there was no surgical confirmation; however, we believe the diagnosis was extremely likely because of the presence of clinical and radiologic criteria for SP. After the diagnosis of SP, all patients had their catheters removed, CAPD was discontinued permanently, and they were transferred to HD. Although there are isolated case reports of successful outcomes after surgical intervention, especially in patients in whom a peritoneal "cocoon" is related to severe peritonitis, usually the prognosis following surgery is poor. Treatment with immunosuppressive agents has been reported to be beneficial in the treatment of SP, although this has not been confirmed by all investigators. Among our SP patients, five (72%) died of sepsis (3/5) in a mean period of 10+/-5 (median, 9; range, 6 to 17) months after the diagnosis of SP and two are still alive on HD. SP is a rare but serious complication of CAPD. Severe peritonitis, especially in patients on dialysis for more than 4 years, may lead to SP As the prevalence of SP increases in patients on long-term CAPD, early detection is important because of the high morbidity and mortality associated with this condition.
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PMID:Sclerosing peritonitis in continuous ambulatory peritoneal dialysis patients: one center's experience and review of the literature. 968 26

Sclerosing peritonitis describes the development of a peel or rind of fibrosis that spreads over the peritoneal surface and can lead to recalcitrant ascites, bowel obstruction, and sepsis. It is well described as a complication of peritoneal dialysis, especially with episodes of bacterial peritonitis. It is also a complication of end-stage liver disease with ascites and liver transplantation. This article describes 3 cases of sclerosing peritonitis present at the time of liver transplantation or soon after. All 3 patients had massive refractory ascites with episodes of spontaneous bacterial peritonitis prior to transplantation. Two patients had evidence of a fibrous peel at the time of transplantation. Postoperatively, all 3 patients continued to have refractory ascites and episodes of peritonitis, along with partial small bowel obstructions, abdominal pain, and malnutrition. Two patients also had constriction of the graft, including biliary obstruction and inferior vena cava and outflow obstruction, which has not been previously described. All 3 patients eventually died from complications related to the sclerosing peritonitis.
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PMID:Sclerosing peritonitis and mortality after liver transplantation. 1932 14