49 | A case of peritoneal sclerosis in a general medicine department

P. Pellino¹, M. La Vella¹, V. Palma², A. Panarese¹, G. Seller¹, M. Ricciuti¹, B. Martin¹, C. Sanrocco¹ | ¹UOSD Medicina Generale PO Popoli Terme (PE); ²UOSD Nefrologia e Dialisi PO, Popoli Terme (PE).

Encapsulating peritoneal sclerosis (EPS) is a rare and life-threatening complication of peritoneal dialysis (PD). Its incidence and prevalence are still not clearly defined, but they increase with the duration of PD treatment;mortality rate is always high. Etiology is unclear, meaby due to the chronic exposure to bioincompatible PD solutions, which cause peritoneal inflammation and long-term modifications of the peritoneum. A 91-year-old-lady was admitted to our department for abdominal pain and constipation. She was treated with PD by 7 years and switched to hemodialysis (HD) about 5 mounths before because of heart failure exacerbation requiring hospitalization. An abdominal ultrasound examination showed ascitic effusione, confirmed by abdominal TC scan, which excluded radiological signs of mechanical or paralytic intestinal obstruction. No laboratory signs of infection or hemodynamic decompensation could be traced. During the days of hospitalization bowel quickly re-channeled thanks to enema;however, the persistence of abdominal tensione required execution of evacuative paracentesis. After that, abdominal TC scan was programmed. The ascitic fluid was an exudate with no evidence of microbiological infection;the cytological test recited:“sample including red blood cells, a few small lymphocytes and some reactive mesothelial cells;no evidence of epithelial neoplasia”. Abdominal TC showed peritoneal effusion extending into the abdominal-pelvic cavity cranio-caudally, surrounding the abdominal organs and displacing intestinal loops posteriorly like a thickened sack of 2 mm that takes contrast medium. Althouth rare, physicians should always suspect EPS in patients with a suggestive history and clinical symptoms indicative of occlusive condition in absence of an alternative diagnosis. The presence of ascites and its analysis can help in the diagnosis, even if radiology plays a crucial role since the tomographic appearance of peritoneum is pathognomonic and allows early diagnosis.