De Oleo Radhames Ramos, Villanueva Hugo, Lwin Lin, Katikaneni Madhavi, Yoo Jinil
New York Medical College, Metropolitan Hospital Center, New York, U.S.A.
Montefiore Medical Center, Wakefield Campus, Bronx, New York, U.S.A.
Adv Perit Dial. 2016;32:19-21.
Encapsulating peritoneal sclerosis (EPS) is an infrequent but serious complication that is observed mostly in patients on long-term peritoneal dialysis (PD). However it can occur after short-term PD, in association with "second hit" risk factors such as peritonitis, acute cessation of PD, or kidney transplantation with the use of calcineurin inhibitors.In our case, a young woman with second-hit risk factors presented with clinical and abdominal computed tomography findings consistent with EPS after short-term PD. She was treated conservatively with nutritional support and was discharged in improved and stable clinical status.In general, the diagnosis of EPS requires clinical findings of bowel obstruction combined with typical computed tomography imaging features. However, the clinical manifestations can be very vague, and the diagnosis is often unclear. A recent study categorized EPS into 4 clinical stages, from pre-EPS to chronic ileus, with associated management from conservative treatment to surgical intervention.In association with second-hit risk factors, EPS can occur after short-term PD. Severity is variable, and the outcome is often devastating. Timely recognition and expert management of EPS can change the outcome very favorably.
包裹性腹膜硬化症(EPS)是一种罕见但严重的并发症,多见于长期进行腹膜透析(PD)的患者。然而,它也可能在短期腹膜透析后发生,与“二次打击”风险因素有关,如腹膜炎、腹膜透析突然停止或使用钙调神经磷酸酶抑制剂进行肾移植。在我们的病例中,一名具有二次打击风险因素的年轻女性在短期腹膜透析后出现了与包裹性腹膜硬化症相符的临床和腹部计算机断层扫描结果。她接受了营养支持的保守治疗,并在临床状况改善且稳定后出院。一般来说,包裹性腹膜硬化症的诊断需要肠梗阻的临床症状并结合典型的计算机断层扫描成像特征。然而,临床表现可能非常模糊,诊断往往不明确。最近的一项研究将包裹性腹膜硬化症分为4个临床阶段,从包裹性腹膜硬化症前期到慢性肠梗阻,并给出了从保守治疗到手术干预的相关处理方法。与二次打击风险因素相关,包裹性腹膜硬化症可在短期腹膜透析后发生。严重程度各不相同,结果往往是灾难性的。及时识别和专业处理包裹性腹膜硬化症可使结果得到非常有利的改变。