title: Intra-peritoneal chronic loculation in peritoneal dialysis patients - a new medical management approach.
abstract: Peritoneal dialysis (PD) limitation as renal replacement therapy is mostly due to peritonitis and complications. Formation and persistence of intra-abdominal loculations is often under-diagnosed. Encapsulated peritoneal sclerosis (EPS) is a life-threatening complication, but malnutrition, recurrent peritonitis and early membrane failure are insidious enemies that need to be emphasized. It is important to highlight the persistence of intra-abdominal fluid collection after clinical resolution of peritonitis in PD patients and to indicate a new medical management approach for an early diagnosis. During five years, we selected PD peritonitis cases followed by a six months interval free of infections. Ninety-seven subjects were followed at six months and one year after the first peritonitis. Tomography had been performed to patients presenting a positive inflammatory state without a specific infectious cause. Subjects presenting documented localized fluid collection (31 cases) were divided into: drug-treated group and those undergoing laparoscopy by a new surgery technique (seven patients); a comparison regarding the clinical state and biohumoral parameters was assessed in both groups. The prevalence of intra-abdominal loculation following an apparent resolved peritonitis was high (31.9%). The cases undergoing laparoscopy presented a better evolution - improved clinical status (p=0.001), higher hemoglobin values (p=0.06), significant lower doses of erythropoietin requirement (p=0.03), improved dialysis adequacy (p=0.005) and inflammatory state. In cases with confirmed fluid encapsulated loculation, an active attitude (screening imaging protocol and laparoscopic exploration) appears to be mandatory, decreasing the risk of EPS, a serious complication which pathology and treatment are incompletely understood.
authors.affiliation: No. 3 Clinical Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; fizij@yahoo.com.
authors.forename: Dan
authors.initials: D
authors.lastname: Mitoiu
authors.forename: Cristiana
authors.initials: C
authors.lastname: David
authors.forename: Ileana
authors.initials: I
authors.lastname: Peride
authors.forename: Andrei
authors.initials: A
authors.lastname: Niculae
authors.forename: Alin
authors.initials: A
authors.lastname: Mureşan
authors.forename: Alexandru
authors.initials: A
authors.lastname: Ciocâlteu
authors.forename: Bogdan Florin
authors.initials: BF
authors.lastname: Geavlete
authors.forename: Ionel Alexandru
authors.initials: IA
authors.lastname: Checheriţă
mesh_terms: D001202:Ascitic Fluid / Q000382:microbiology; D015415:Biomarkers / Q000378:metabolism; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D010537:Peritoneum / Q000473:pathology* / Q000601:surgery; D010538:Peritonitis / Q000000981:diagnostic imaging / Q000601:surgery*; D011182:Postoperative Care; D011859:Radiography; D012008:Recurrence
chemical_list: D015415:Biomarkers