Quiz page November 2007: A Peritoneal Dialysis Patient With HIV Infection and Abdominal Pain

What does the abdominal tomography show? 

Abdominal tomography in Fig 1 shows extensive calcification of the peritoneum, with the bowel loops incorporated in a cocoon-like mass and loculated ascites.

What is your diagnosis? 

These findings are consistent with the diagnosis of sclerosing encapsulating peritonitis. The patient was transferred to hemodialysis therapy and prescribed tamoxifen, 40 mg, and prednisone, 60 mg/d. Enteral nutrition was started. The patient’s condition initially improved, but he died 2 months later of likely abdominal sepsis. Autopsy was not performed.

Sclerosing encapsulating peritonitis is a rare, but fatal, complication of long-term peritoneal dialysis. It should be suspected in peritoneal dialysis patients who develop a clinical syndrome compatible with bowel obstruction.1 Although the cause is unknown, risk factors include previous episodes of peritonitis, high glucose or lactate dialysate, and such medications as β-blockers and chlorhexidine.2, 3 Steroids and anti-inflammatory and immunosuppressive drugs have been used for treatment, but mortality remains high (60% to 90%).