Sclerosing Encapsulated Peritonitis: A devastating and infrequent disease complicating kidney transplantation, case report and literature review.
BACKGROUND
Sclerosing Encapsulating Peritonitis (SEP) is a rare condition with an incidence of up to 3% and a mortality of up to 51% among peritoneal dialysis (PD) patients (Brown et al., Korte et al. and Kawanishi et al.). In the last ten years, the incidence of SEP in kidney transplant recipients has increased (Nakamoto, de Sousa et al. and Korte et al.).


METHODS
A 31-year old male with a 15 years history of PD and later kidney retransplantation was admitted to the emergency service after experiencing several weeks of diffuse abdominal pain which had escalated to include vomiting and diarrhea during the 24h previous to admission. The patient underwent an exploratory laparotomy where severe peritoneal thickening was found, in addition to signs of chronic inflammation and blocked intestinal loops. Histopathologic findings were suggestive of sclerosing peritonitis. After two months of treatment in hospital, the patient presented an obstructed intestine, with a rigid and thickened peritoneum compromising all the intestinal loops.


CONCLUSIONS
Despite being rare, SEP, represents a significant complication due to its high mortality and recurrence. It is insidious in its early stages and culminates in an intestinal obstruction (Fieren). Risk factors for its development in kidney transplant recipients include a history of prolonged treatment with PD and the use of calcineurin inhibitors as an immunosuppressive treatment (Korte et al.).


CONCLUSIONS
Given the increase in the incidence of SEP in kidney transplant recipients, the clinician should be alert to the presence of this complication. A greater number of multi-centre studies are required to identify the risk factors for SEP that are inherent in renal transplant recipients.
Transplant Surgery Department, Fundación Valle de Lilí, Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia.
Liliana
L
Caicedo
Centro de Investigaciones Clínicas, Fundación Valle del Lilí, Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia.
Alejandro
A
Delgado
Transplant Surgery Department, Fundación Valle de Lilí, Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia.
Luis A
LA
Caicedo
Pathology Department, Fundación Valle de Lilí, Cali, Colombia.
Juan Carlos
JC
Bravo
Centro de Investigaciones Clínicas, Fundación Valle del Lilí, Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia.
Laura S
LS
Thomas
Radiology Department, Fundación Valle de Lilí, Cali, Colombia.
Martin
M
Rengifo
Transplant Surgery Department, Fundación Valle de Lilí, Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia.
Jorge I
JI
Villegas
Transplant Surgery Department, Fundación Valle de Lilí, Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia.
Oscar
O
Serrano
Transplant Surgery Department, Fundación Valle de Lilí, Centro para la Investigación en Cirugía Avanzada y Trasplantes, Universidad ICESI, Cali, Colombia. Electronic address: gjecheverri@icesi.edu.co.
Gabriel J
GJ
Echeverri
Calcineurin inhibitors; Case report; Kidney transplant; Peritoneal dialisis; Sclerosing encapsulating peritonitis