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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2015  |  Volume : 26  |  Issue : 5  |  Page : 1018-1019
Comment to case report encapsulating peritoneal sclerosis (EPS): Presentation without preceding symptoms


Nephrology and Dialysis Department, Civico and Di Cristina Hospital, Palermo, Italy

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Date of Web Publication7-Sep-2015
 

How to cite this article:
Cavoli GL, Tralongo A, Schillaci O, Ferrantellii A, Li Cavoli TV, Tralongo P, Ferrantelli G, Rotolo U. Comment to case report encapsulating peritoneal sclerosis (EPS): Presentation without preceding symptoms. Saudi J Kidney Dis Transpl 2015;26:1018-9

How to cite this URL:
Cavoli GL, Tralongo A, Schillaci O, Ferrantellii A, Li Cavoli TV, Tralongo P, Ferrantelli G, Rotolo U. Comment to case report encapsulating peritoneal sclerosis (EPS): Presentation without preceding symptoms. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2020 Jun 4];26:1018-9. Available from: http://www.sjkdt.org/text.asp?2015/26/5/1018/164596
To the Editor,

We read with interest the article of Dr. P. Yiannoullou et al, [1] and we would like to describe our experience highlighting similar clinical findings.

A 71-year-old Caucasian female on automated peritoneal dialysis (PD) for five years developed a severe bowel obstruction. Her medical history included peritonitis due to Enterococcus faecalis. She was suffering from chronic colonic diverticular disease without previous obstructive episodes. She did not exhibit signs of significant malnutrition nor symptoms of gastrointestinal dysfunction. The adequacy of PD treatment was always according to the guidelines. On admission, the dialysate leukocyte counts and the cultures were negative for peritoneal infection. Unlike the case reported by the authors, the CT-scan of our patient showed the pathognomonic cocoon. Because of the severe intestinal obstruction, the patient underwent surgical intervention. At laparotomy, under a dense sclerotic membrane, we found thickening of the intestinal wall and entrapment of the small bowel in a fibrous tissue; before the ileocecal valve, a cocoon-like encapsulation was surrounding the last 80 cm of the small bowel loops. We detected a single intestinal perforation in the small intestine last loop. An ileocecal resection and an ileocolic anastomosis were performed, but after 12 h the patient died with a septic shock. Peritoneal biopsies showed massive alterations in the peritoneal membrane with a PD-induced chronic tissue damage consisting of mesothelial denudation and interstitial fibrosis.

Comparable to the experience of Dr. P. Yiannoullou et al, [1] we stress on the insidious pattern of the onset of the EPS, which is gradual in most reported cases. The "two-hit" hypothesis highlights the balance between two factors, PD-induced peritoneal damage and superimposed inflammation. This theory explains why EPS tends to occur in long-term PD patients, but the exact cause and pathogenesis are still not clear. In the present case, among the suggested predisposing factors of the EPS, we detected the duration of PD longer than five years and the episode of peritonitis. We cannot exclude subclinical episodes of peritonitis that could explain a possible transition from simple sclerosis to EPS.

In our patient, we report a fast course for her symptoms and we agree with the authors on the insidious nature of the EPS.

 
   References Top

1.
Yiannoullou P, Kanesalingam K, van Dellen D, Augustine T. Encapsulating peritoneal sclerosis: Presentation without preceding symptoms. Saudi J Kidney Dis Transpl 2015;26:329-34.  Back to cited text no. 1
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Correspondence Address:
Dr. Gioacchino Li Cavoli
Nephrology and Dialysis Department, Civico and Di Cristina Hospital, Palermo
Italy
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DOI: 10.4103/1319-2442.164596

PMID: 26354583

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