Imaging diagnosis of sclerosing peritonitis and relation of radiologic signs to the extent of the disease
Sclerosing peritonitis (SP) is a serious complication of chronic ambulatory peritoneal dialysis (CAPD) that is characterized by thickened peritoneal membranes, leading to impaired ultrafiltration and intestinal obstruction. The aim of this study was to analyze the radiographic signs of SP in symptomatic patients and to compare them with the histological severity of the disease.
In 14 patients with symptoms of intestinal obstruction related to SP, plain films of the abdomen, upper GI follow-through examinations, ultrasonography, and computed tomography were evaluated retrospectively. Imaging findings such as bowel motility, bowel wall and peritoneal thickness, and the presence of intraperitoneal fluid collections were correlated to the histological degree of the fibrosis.
Signs of intestinal obstruction and disturbed motility were present in all cases. In addition, patients with histologically severe SP had loculated fluid collections, thickening of the bowel wall and/or peritoneum, peritoneal calcifications, and thickened peritoneal membranes, and suffered more often from postoperative complications.
The detection of characteristic radiographic signs in CAPD patients presenting with symptoms of intestinal obstruction may suggest the presence of severe SP and should lead to cautious surgical interventions.
Key wordsSclerosing peritonitis Radiologic signs, CT Ultrasound, CAPD
Unable to display preview. Download preview PDF.
- 1.Hoffmann R, Largiadèr F, Keusch G, Binswanger U. Abdominale Komplikationen bei Patienten mit kontinuierlicher ambulanter Peritonealdialyse (CAPD)Helv Chir Acta 1986;53:837–842Google Scholar
- 2.Tenckhoff H.Chronic peritoneal dialysis. A manual for patients, personnel and physicians. Seattle: University of Washington School of Medicine. 1984:57–61Google Scholar
- 3.Bradley JA, Hamilton DNH, McWhinnie DL, Briggs JD, Junor BJR. Sclerosing peritonitis after CAPD.Lancet 1983;2:572–573Google Scholar
- 4.Gandhi VC, Humayun HM, Ing TS, Daugirdas JT, Jablokow VR, Iwatsuki S, Geis P, Hano JE. Sclerotic thickening of the peritoneal membrane in maintenance peritoneal dialysis patients.Arch Intern Med 1980;140:1201–1203Google Scholar
- 5.Schmidt RW. Peritoneal sclerosis. A “sword of Damocles” for peritoneal dialysis?Arch Intern Med 1981;141:1265–1267Google Scholar
- 6.Dobbie JW. Pathogenesis of peritoneal fibrosing syndromes (sclerosing peritonitis) in peritoneal dialysis.Perit Dial Int 1992;12:14–27Google Scholar
- 7.Drukker W. European nephrology notes. Sclerosing peritonitis.D+T Int 1984;13:768A-768GGoogle Scholar
- 8.Ahmad S. Sclerosing peritonitis and propranolol.Chest 1981;79:361–362Google Scholar
- 9.Brown P, Baddeley H, Read AE, Davies JD, McGarry J. Sclerosing peritonitis, an unusual reaction to a beta-adrenergic blocking drug (practolol).Lancet 1974;2:1477–1481Google Scholar
- 10.Eltringham WK, Espinger HJ, Windsor CWO, Griffiths DA, Davies JD, Baddeley H, Read AEA, Blunt RJ. Sclerosing peritonitis due to practolol: a report on 9 cases and their surgical management.Br J Surg 1977;64:229–235Google Scholar
- 11.Sieck JO, Cowgill R, Larkworthy W. Peritoneal encapsulation and abdominal cocoon.Gastroenterology 1983;84:1597–1601Google Scholar
- 12.Verger C, Celicout B. Peritoneal permeability and encapsulating peritonitis.Lancet 1985;1:986–987Google Scholar
- 13.Cox SV, Lai J, Suranyi M, Walker N. Sclerosing peritonitis with gross peritoneal calcification: a case report.Am J Kidney Dis 1992;20:637–642Google Scholar
- 14.Korzets A, Korzets Z, Peer G, Papo J, Stern D, Bernheim J, Blum M. Sclerosing peritonitis. Possible early diagnosis by computerized tomography of the abdomen.Am J Nephrol 1988;8:143–146Google Scholar
- 15.Holland P. Sclerosing encapsulating peritonitis in chronic ambulatory peritoneal dialysis.Clin Radiol 1990;41:19–23Google Scholar
- 16.Hollman AS, McMillan MA, Briggs JD, Junor BJR, Morley P. Ultrasound changes in sclerosing peritonitis following continuous ambulatory peritoneal dialysis.Clin Radiol 1991;43: 176–179Google Scholar