Images in Clinical Medicine
Sclerosing Peritonitis during Continuous Ambulatory Peritoneal Dialysis
N Engl J Med 2002; 347:737September 5, 2002
- Article
Figure 1 A 45-year-old man who was receiving long-term continuous ambulatory peritoneal dialysis for renal failure presented with a two-month history of colicky abdominal pain, weight loss, and vomiting. The dialysis fluid contained standard levels of sodium (132 mmol per liter), magnesium (0.25 mmol per liter), chloride (95 mmol per liter), and lactate (40 mmol per liter) and a low level of calcium (1.25 mmol per liter). A plain abdominal film showed the typical findings of sclerosing peritonitis: diffuse calcification of the peritoneum (arrow in Panel A) and small-bowel dilatation. Computed tomography of the abdomen showed both peritoneal and mesenteric thickening with calcification (arrow in Panel B) and collection of fluid. A few weeks after the diagnosis, the patient died of septic shock as a result of cecal perforation. The postmortem findings confirmed the diagnosis. Continuous ambulatory peritoneal dialysis remains an important form of renal-replacement therapy. Sclerosing peritonitis is a serious and often fatal complication of continuous ambulatory peritoneal dialysis and frequently is misdiagnosed. In patients who receive continuous ambulatory peritoneal dialysis for a prolonged time, the possibility that sclerosing peritonitis is a cause of abdominal pain, even after the removal of the catheter, must be borne in mind.
Colin Church, M.B., Ch.B.
Brian Junor, M.D.
Western Infirmary, Glasgow G11, Scotland- Citing Articles (2)
