RESUMEN
La Peritonitis Esclerosante (PE) es una entidad grave que puede aparecer en pacientes en Diálisis Peritoneal (DP) con una morbi-mortalidad elevada. Describimos nuestra experiencia con pacientes diagnosticados de PE, sus características y evolución clínica. De 190 pacientes en DP durante un periodo de 17 años, hubo ocho casos de PE. Edad media 45 ± 14 años (rango 29-64), cuatro eran varones. Tiempo en DP 72 ± 29 meses.Todos presentaron episodios de peritonitis previa (media 3 ± 1 episodios). Se observó un cambio en las características de transporte peritoneal (D/P Cr 4);media de 0,6 ± 0,1 al año de DP, frente a 0,82 ± 0,08 al final de DP (p < 0,001). Incremento en el uso debolsas hipertónicas: 53% ± 28 al inicio frente 91% ± 27 al final (p < 0,009). Cinco pacientes (62,5%) recibieron un injerto renal previo: uno con pérdida de función precoz por trombosis y dos por rechazo agudo. Seis pacientes (75%) tuvieron cirugía abdominal previa, en todos fue extraperitoneal. El diagnóstico de PE fue clínico en todos los casos, con datos radiológicos sugestivos y confirmación laparoscópica e histológica (fibrosis y calcificación peritoneal) en cuatro casos. Seis pacientes fueron intervenidos: tres de forma urgente (éxitus en todos) y tres de forma programada (uno falleció). En seis pacientes se realizó tratamiento médico (tamoxifeno y/o esteroides), asociado connutrición parenteral en dos y nutrición enteral en uno. Cuatro de esos seis pacientes necesitaron además tratamiento quirúrgico. Causas de éxitus: tres por sepsis, uno por peritonitis post-perforación intestinal y uno por malnutrición severa. Media de supervivenciade los tres pacientes que viven es de 38 ± 17 meses, dos de ellos habían sido intervenidos y el tercero era una trasplantada que se optó por tratamiento conservador.Conclusión: La PE es una entidad severa con mortalidad elevada. Aunque nuestra escasa experiencia no permite recomendar una pauta terapéutica concreta, nuestra impresión es que la cirugía precoz cuando existe obstrucción (PE encapsulante) seguida detratamiento esteroideo puede mejorar el pronóstico
Sclerosing Encapsulating Peritonitis (SEP) is a rare but serious complication of continuous ambulatory peritoneal dialysis (CAPD) with a high morbi-mortality. We describe our experience with patients was diagnostic of SEP, their characteristics in CAPD and their clinic evolution after diagnosis. 190 CAPD patients were follow-upduring 17 years. Eight patients (4,2%) developed SEP. Average age 45 ± 14 years (range 29-64 years), four was male. Time in CAPD was 72 ± 29 months (range 24-120 months). All patients have peritonitis previously (mean 3 ± 1). We observe a change in peritoneum characteristics (D/P Cr 4), with an average of 0.6 ± 0.1 at one year of CAPD, versus 0.82 ± 0.08 at the end of CAPD, with statistic significance (p < 0.001). There are increases in use of hypertonic bags: 53% ± 28 at beginning versus 91% ± 27 at end, with statistic significance (p < 0.009). All patients show tendencyto hyperphosphoremia (mean 6.7 ± 0.7 mg/dl), with product calcium-phosphorus 68.4 ± 8.3. Five patients (62.5%) have a previous renal transplant, one lost due toearly graft thrombosis and two lost due to acute rejection. Six patients (75%) have a previous abdominal surgery, although was extra peritoneal in all cases. The diagnosis of SEP was clinic suspicion in all cases, suggestive radiological data (intestinal handlegroup) and laparoscopy showing SEP (cocoon) with histological confirmation (fibrosis and peritoneal calcification) in four cases. The treatment was medical in six cases associated with surgery in four of them. The medical treatment was tamoxifen and/or corticosteroids, associated with total parenteral nutrition in two patients and enteral nutrition in one. Surgery in six patients: three as urgent surgery (all died) and three as programme surgery (two live still). Etiology of died was: three for sepsis, one for peritonitis after bowel perforation, one for severe problems of nutrition. The average survival of three patients alive was 38 ± 17 months, two of them had programme surgery, and one with functioning transplant we opt for conservative treatment. The actuarial survival at 24 months was 51%. Conclusion: The SEP is a serious entity with high mortality. Although our short experience doesnt can indicate a concrete treatment, our personal impression is that early surgery associated with corticosteroidstreatment may improve the prognostic
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Peritonitis/cirugía , Esclerosis , Diálisis Peritoneal/efectos adversos , Peritonitis/diagnóstico , Peritonitis/etiología , Diálisis Peritoneal/métodos , Evolución Clínica , PronósticoRESUMEN
UNLABELLED: Sclerosing Encapsulating Peritonitis (SEP) is a rare but serious complication of continuous ambulatory peritoneal dialysis (CAPD) with a high morbi-mortality. We describe our experience with patients was diagnostic of SEP, their characteristics in CAPD and their clinic evolution after diagnosis. 190 CAPD patients were follow-up during 17 years. Eight patients (4.2%) developed SEP. Average age 45+/-14 years (range 29-64 years), four was male. Time in CAPD was 72+/-29 months (range 24-120 months). All patients have peritonitis previously (mean 3+/-1). We observe a change in peritoneum characteristics (D/P Cr 4), with an average of 0.6+/-0.1 at one year of CAPD, versus 0.82+/-0.08 at the end of CAPD, with statistic significance (p<0.001). There are increases in use of hypertonic bags: 53%+/-28 at beginning versus 91%+/-27 at end, with statistic significance (p<0.009). All patients show tendency to hyperphosphoremia (mean 6.7+/-0.7 mg/dl), with product calcium-phosphorus 68.4+/-8.3. Five patients (62.5%) have a previous renal transplant, one lost due to early graft thrombosis and two lost due to acute rejection. Six patients (75%) have a previous abdominal surgery, although was extra peritoneal in all cases. The diagnosis of SEP was clinic suspicion in all cases, suggestive radiological data (intestinal handle group) and laparoscopy showing SEP (cocoon) with histological confirmation (fibrosis and peritoneal calcification) in four cases. The treatment was medical in six cases associated with surgery in four of them. The medical treatment was tamoxifen and/or corticosteroids, associated with total parenteral nutrition in two patients and enteral nutrition in one. Surgery in six patients: three as urgent surgery (all died) and three as programme surgery (two live still). Etiology of died was: three for sepsis, one for peritonitis after bowel perforation, one for severe problems of nutrition. The average survival of three patients alive was 38+/-17 months, two of them had programme surgery, and one with functioning transplant we opt for conservative treatment. The actuarial survival at 24 months was 51%. CONCLUSION: The SEP is a serious entity with high mortality. Although our short experience doesn't can indicate a concrete treatment, our personal impression is that early surgery associated with corticosteroids treatment may improve the prognostic.