ABSTRACT Encapsulating peritoneal sclerosis (EPS) is a rare complication of peritoneal dialysis which mortality can reach 50%. The usual treatment involves suspension of the technique, medical treatment, and surgical enterolysis. We report the case of a 36-year-old female who undergone continuous ambulatory peritoneal dialysis without complications for 10 years. She presented at the emergency department with abdominal pain and a diagnosis of peritonitis was assumed. The patient developed a systemic inflammatory response, and her abdominal computer tomography (CT) scan showed multiple parietal calcifications. After multiple broad-spectrum antibiotics, an undetermined febrile syndrome persisted, and parenteral nutrition was started. An EPS diagnosis was established and treatment with tamoxifen was proposed. Exploratory laparoscopy was decided, and the intraoperative findings were consistent with EPS. The patient was submitted to extensive enterolysis. A clinical improvement led to a discharge after 60 days of hospitalization. After more than 30 months with tamoxifen, she remains on hemodialysis and doing well. There are no randomized controlled trials to guide EPS management and the following procedures are more difficult to decide, who makes these reports important to the reflection. We describe a case of successful treatment of EPS, with a very severe presentation. The management with enterolysis and tamoxifen contributed decisively to this outcome.

Objectivo: Determinar a incidência, etiologia, preditores e prognóstico dos casos de peritonite nos nossos doentes em Diálise Peritoneal (DP). Doentes e métodos: Um estudo observacional retrospectivo foi realizado em 59 doentes durante um período de 10 anos e englobou a epidemiologia, apresentação clínica, perfil microbiológico, tratamento e prognóstico dos nossos casos de peritonite. Resultados: Foram contabilizadas 88 peritonites em 31 doentes (idade média 43 ±15 anos), com ocorrência predominante no sexo masculino (68,0% vs. 39.0%, p < 0,01) e incidência calculada de 0,57 peritonites.doente.ano. O agente mais frequentemente identificado foi o Staphylococcus coagulase-negativo (25,9%). Encontrámos associação entre as peritonites por Staphylococcus aureus (17,0%) e a ocorrência de peritonites de repetição (44,4% vs. 14,3%, p = 0,02). Nestes casos, metade dos doentes eram portadores nasais e cinco casos (33%) foram precedidos de infecção do orifício de saída do cateter por este agente. As peritonites estéreis (15,9%) apresentaram contagem leucocitária peritoneal inicial inferior (< 1500 cell/mm3: 64,3% vs. 32,4%, p = 0,02) e as onze peritonites refractárias contabilizadas associaram -se a maior duração da antibioterapia (34 vs. 20 dias, p < 0,01), de internamento (16 vs. 5 dias, p < 0,01) e a remoção do cateter de DP foi necessária em oito casos. A cura foi atingida na maioria dos casos (n = 80, 90, 9%) mas sete doentes foram transferidos para hemodiálise e ocorreu uma morte por peritonite. A sobrevida da técnica aos 36 meses dos doentes com peritonite foi de 80%. A transferência da hemodiálise (OR 5,9; CI 95%: 1,2 -29,3) e o sexo masculino (OR 5,1; CI 95%: 1,02 - 25,1) foram os fatores de risco apurados para ocorrência de peritonite no primeiro ano da técnica. Considerando todos os doentes, o risco de peritonites cumulativas ( ≥ 3 episódios) foi superior nos doentes com episódio de peritonite no primeiro ano da técnica (OR 10,28; CI 95%: 1,27 -83,32). A idade e diabetes mellitus não conferiram maior risco para estes eventos. Conclusão: Os resultados obtidos foram globalmente satisfatórios. A transferência da hemodiálise e o sexo masculino foram identificados como fatores de risco para peritonite no primeiro ano da técnica. Este evento precoce está associado a maior risco para a ocorrência de três ou mais peritonites nestes doentes durante o tempo em DP.

Aims: Evaluate the incidence, aetiology, predictors and outcomes of peritonitis in our chronic peritoneal dialysis (PD) patients. Patients and methods: A retrospective observational study was carried out in 59 patients during a ten-year period, which included the epidemiology, clinical presentation, microbiology profile, treatment and outcomes of all peritonitis episodes. Results: A total of 88 peritonitis occurred in 31 patients (mean age 43 ±15 years), with a peritonitis rate of 0.57 episodes.patient.year. Male gender (68.0% vs. 39.0%, p < 0.01) was associated with events. Coagulase-negative Staphylococcus was the most frequent agent (25.9%). Staphylococcus aureus peritonitis (17.0%) was associated with repeat peritonitis (44.4% vs. 14.3%, p = 0.02). Nasal carriage of this agent was found in half the patients and five (33.3%) episodes were preceded by exit-site infection. Culture negative peritonitis (15.9%) had lower initial peritoneal leukocyte count (< 1500 cell/mm3: 64.3% vs. 32.4%, p = 0.02). Eleven refractory peritonitis were reported and associated with longer time of treatment (34 vs. 20 days, p < 0.01) and hospital stay (16 vs. 5 days, p < 0.01). The peritoneal catheter was removed in eight cases. Cure was achieved in the majority of cases (n = 80; 90.9%), seven patients were transferred to haemodialysis, and one died. The technique survival rate at 36 months was 80%. Greater risk of peritonitis in the first year was identified in patients transferred from haemodialysis (OR 5.9; CI 95%: 1.2 -29.3) and male gender (OR 5.1; CI 95%: 1.02 - 25.1). Considering all PD patients, first year peritoneal dialysis episode was associated with higher risk for cumulative peritonitis (≥ 3) (OR 10.28; CI 95%: 1.27 -83.32). Diabetes and older age were not associated to higher risk of these events. Conclusion: The overall results of peritonitis episodes were satisfactory. Transfer from haemodialysis and male gender were associated with higher risk for first -year peritonitis. This early event was associated with a greater risk of occurrence of three or more peritonitis in those patients.