Abdominal cocoon in peritoneal dialysis--a fatal outcome.

1 of 2 DESCRIPTION Sclerosing peritonitis (SP, encapsulating peritoneal sclerosis or abdominal cocooning) is an infl ammatory process affecting the peritoneum diffusely and constitutes a rare but life-threatening (fi gure 1), serious complication in patients on long-term continuous ambulatory peritoneal dialysis (CAPD). 1 2 An overall prevalence of 0.7% 2 has been described in literature. The pathogenicity of this condition still remains unclear. Predisposing factors described in the literature include episodes of infective peritonitis, prolonged duration on CAPD, the use of chlorhexidine in alcohol-sterilising sprays, acetate and hyperosmolar dialysate. 2 3 SP is a wide-spread evolution involving the accumulation of new fi brous tissue that encapsulate and limit the viscera, thereby compromising the bowel motility. 3 A slow reduction of peritoneal permeability by the fi brous tissue leads to ultrafi ltration failure of CAPD. This slow evolving process causes malnutrition to worsen. Abdominal discomfort with evidence of complete or partial bowel obstruction is the usual clinical presentation. 2 3 Classical CT fi ndings (fi gures 2 and 3) include thickened adhered bowel loops, loculated ascites and peritoneal enhancement. Initial management involves the removal of dialysis catheter, discontinuation of CAPD, bowel rest and total parental nutritional support. 4 The use of steroids, immunosuppressives and tamoxifen has been reported to be benefi cial, but needs to be validated. Surgery is high risk for fi stula formation and anastomotic leakage. Despite various therapeutic modalities, the death rate is 56–93%. 4