Al-Lawati Ali I, Al Shaibi Maha, Al Mahruqi Ghaitha, Augustine Titus, Moinuddin Zia, Al Hinai Meerah, Al Moqbali Rana, Al Qadhi Hani
Department of Nephrology, Sultan Qaboos University Hospital, Muscat, Oman.
Department of Surgical Oncology, Sultan Qaboos University Hospital, Muscat, Oman.
Am J Case Rep. 2020 Oct 4;21:e925341. doi: 10.12659/AJCR.925341.
BACKGROUND Encapsulating peritoneal sclerosis (EPS) is a rare, life-threatening, and serious complication of long-term peritoneal dialysis (PD). No evidence-based management strategy has been established until now. Surgical management, including enterolysis and excision of the sclerotic and obstructing adhesions, should be considered as soon as conservative management fails to work. We report a case of EPS soon after transplantation in a patient with end-stage kidney disease who had been on long-term PD. CASE REPORT A 26-year-old man had been found to have advanced chronic kidney disease secondary to glomerulonephritis on pre-employment investigation. He was on continuous ambulatory PD for 5 years, after which he underwent a living donor renal transplant from his full HLA-matched sibling. He did well postoperatively, with excellent graft function. One month after transplantation, he repeatedly presented to our Emergency Department with signs and symptoms of complete small-bowel obstruction. Computed tomography of the abdomen showed features of small-bowel obstruction secondary to interloop adhesions. The patient was initially managed conservatively; however, as his condition continued to deteriorate, an exploratory laparotomy was carried out. Operative findings were suggestive of early EPS localized to the terminal ileum. Total enterolysis along with peritonectomy was performed along with resection of the diseased and obstructing terminal ileum. The patient did well, and he was discharged home day 10 postoperatively. CONCLUSIONS EPS remains a serious and fatal complication of long-term PD. Early definitive diagnosis, treatment, and ultimately surgical intervention may be required to prevent the morbidity and mortality associated with this condition.
包裹性腹膜硬化症（EPS）是长期腹膜透析（PD）罕见、危及生命的严重并发症。目前尚未确立基于证据的管理策略。一旦保守治疗无效，应考虑手术治疗，包括肠粘连松解术以及切除硬化和阻塞性粘连组织。我们报告1例终末期肾病长期接受PD治疗的患者在移植后不久发生EPS的病例。
一名26岁男性在入职前检查时被发现患有继发于肾小球肾炎的晚期慢性肾病。他持续非卧床腹膜透析5年，之后接受了来自其全相合HLA配型同胞的活体供肾移植。术后他恢复良好，移植肾功能出色。移植后1个月，他多次因完全性小肠梗阻的症状和体征就诊于我院急诊科。腹部计算机断层扫描显示为肠袢间粘连继发小肠梗阻的特征。患者最初接受保守治疗；然而，由于病情持续恶化，遂进行了剖腹探查术。手术结果提示早期EPS局限于回肠末端。进行了全肠粘连松解术、腹膜切除术以及切除病变和阻塞性的回肠末端。患者恢复良好，术后第10天出院。
EPS仍然是长期PD的严重致命并发症。可能需要早期明确诊断、治疗以及最终的手术干预，以预防与此病症相关的发病率和死亡率。
