[Implementing HPN in an SEP case following long-term CAPD].
BACKGROUND
Sclerosing encapsulating peritonitis (SEP) is one of the most serious complications in continuous ambulatory peritoneal dialysis (CAPD). SEP causes severe bowel obstruction leading to malnutrition and eventually to a high mortality rate. The basic strategy for the care of SEP is to sustain the rest of the bowel, i.e., long-term TPN. We report a case successfully restored to a useful life through HPN.


METHODS
The patient is a 26-year-old man, diagnosed as primary nephrotic syndrome in 1980. He had to begin hemodialysis (HD), which was immediately switched to CAPD, due to uremia in 1983. He had been on CAPD for 12 years since that time. He developed SEP as a serious complication of CAPD in July, 1995. CAPD was discontinued, and maintenance HD was started three times a week. Although only liquid diet (such as Renalen and Ensure-Liquid) was allowed as a meal, he often developed intermittent bowel obstruction and repeated hospitalizations were needed to relieve the symptoms. Home parenteral nutrition (HPN) was implemented in May, 1997, in the hope of improving his quality of life. No hospitalization has been needed since then. At present, he is working as an active pharmacist utilizing the HPN system developed by Terumo Co., Ltd. So far a few HPN pump failures have been encountered, but they were promptly handled by the Home Health Care Business Project staff at Terumo Co., Ltd.


CONCLUSIONS
Although further improvements of the present HPN system are necessary, HPN can be a useful tool to effectively manage SEP patients who are suffering from persistent or intermittent bowel obstruction.
Kaneko
K
K
Sagamidai Hospital, Pharmacy.
Hidaka
K
K
Koyama
K
K
Ishii
J
J
Yokota
S
S
Ouchi
T
T
D000328:Adult; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009404:Nephrotic Syndrome / Q000628:therapy; D016331:Parenteral Nutrition, Home; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D010538:Peritonitis / Q000209:etiology / Q000628:therapy*