Sclerosing peritonitis (SP) is a rare but serious complication of Peritoneal Dialysis (PD). SP is associated with complications of bowel obstruction, sepsis and malnutrition. It has a poor long-term prognosis and very high mortality rates. In the most severe form, sclerosing encapsulating peritonitis (SEP), the intestine is entrapped by a fibrous sac resulting in complete intestinal obstruction.
A 33 year old woman, developed signs of SP in November 2004 after nine years on PD. Her usual dry weight of 53kg had dropped to 48kg by March 2005. Initial nutritional management was oral nutritional supplements (ONS), which provided up to 1400 kcal/day in addition to her food intake. Abdominal pain, nausea, vomiting and poor appetite continued over the next 12 months, along with hospital admissions for intermittent bowel obstructions.
Intradialytic Parenteral Nutrition (IDPN), which provides nutritional substrates intraveneously at the time of dialysis, was commenced in February 2006 when her weight was 35kg. The IDPN provided ∼1300 kcal during each HD session (3x/week). After nine months on IDPN her weight had increased to 40kg, but as SP symptoms continued to worsen, her weight dropped back to 36.5kg by March 2007.
Total Parenteral Nutrition (TPN) was commenced at this time and continues today, with the patient administering her own TPN at home five days/week. With further complications of SEP, including an entero-vesicular fistula requiring ongoing drainage, her weight is now 49kg. This case demonstrates that in severe forms of SP, nutritional supplementation with ONS and/or IDPN is inadequate to meet requirements.