Encapsulated Peritoneal Sclerosis Masquerading as an Abdominal Catastrophe in Peritoneal Dialysis Therapy.
Encapsulated Peritoneal Sclerosis Masquerading as an Abdominal Catastrophe in Peritoneal Dialysis Therapy.
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DOI：
10.7759/cureus.12934
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发表时间：
2021-01-27
期刊：
影响因子：
--
通讯作者：
Shukla A
中科院分区：
文献类型：
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作者：
Leeoloy J;Kambojia M;Wagle Shukla A;Liu X;Shukla A
包裹性腹膜硬化（EPS）是终末期肾病（ESRD）患者腹膜透析（PD）治疗中一种罕见但已知的并发症。它通常表现为复发性肠梗阻和营养不良，随着时间的推移而恶化。我们报告一位接受PD治疗6年的ESRD患者，表现为急性肠梗阻、肠疝、肠缺血和血流动力学不稳定。腹部CT示右下腹结肠、回肠壁增厚，伴小肠梗阻征象。患者急诊开腹行疝修补及缺血性肠切除术，术中发现远端肠暗沉、水肿、增厚、炎症、膨胀，右下腹部粘连。病理检查显示一薄膜弥漫性包裹回肠、结肠及肠系膜组织。切除肠镜下检查显示明显的粘膜下水肿伴粘液样和炎性改变。根据这些临床，影像学和病理结果，建立了EPS的诊断。术后复发性腹腔出血伴腹腔积血，导致弥漫性血管内凝血，多器官功能衰竭，术后两周死亡。EPS可表现为急性腹部灾难。虽然有确定EPS诊断的建议，但没有明确的安全有效的手术策略指南，这些值得进一步研究。
Encapsulated peritoneal sclerosis (EPS) is a rare but known complication of peritoneal dialysis (PD) therapy in patients with end-stage renal disease (ESRD). It commonly manifests insidiously with recurrent intestinal obstruction and malnutrition, worsening over time. We report an ESRD patient on PD therapy for six years presenting with an acute intestinal obstruction, bowel hernia, bowel ischemia, and hemodynamic instability. CT abdomen revealed thickening of walls of colon and ileum in the right lower quadrant, with signs of small bowel obstruction. Patient underwent emergency laparotomy for the repair of hernia and resection of ischemic bowel, and intraoperatively, was found to have dusky, edematous, thickened, inflamed, and distended distal bowels with adhesions in the right lower quadrant. The pathological examination revealed a thin membrane encasing the ileum, colon and the mesenteric tissue diffusely. Microscopic examination of resected bowel showed marked submucosal edema with myxoid and inflammatory changes. Based on these clinical, radiological and pathological findings, a diagnosis of EPS was established. Her postoperative course was complicated by recurrent intraabdominal bleeding with hemoperitoneum, leading to disseminated intravascular coagulation, multiorgan failure, and death, two weeks after the surgery. EPS can present as an acute abdominal catastrophe. Although there are recommendations for ascertainment of EPS diagnosis, there are no clear guidelines for safe and effective surgical strategies and these warrant further research.