[Encapsulating peritonitis during continuous ambulatory peritoneal dialysis. A physiopathologic hypothesis].

A case of sclerosing encapsulating peritonitis was observed in a patient who had been treated by continuous ambulatory peritoneal dialysis for 4 years. During that period the patient had always used a lactate buffered dialysate (Dianeal solution, supplied by Travenol) and no disinfectant. Nine episodes of peritonitis occurred during the first two years of dialysis. At the end of the first year the patient had decreased ultrafiltration associated with high glucose absorption. A peritoneal biopsy performed at that time showed mesothelial alterations and desquamation. Sclerosing encapsulating peritonitis was suspected at the end of the fourth year, on the basis of changes in the glucose equilibration curve which showed that poor ultrafiltration was now associated with very slow glucose absorption. The diagnosis was confirmed at laparotomy. The authors suggest that the first stage of encapsulating peritonitis might be prolonged and severe alteration of the mesothelial layer. Dialysis should be discontinued immediately in the presence of a loss of filtration with hypermeability (type I) in order to permit normal recovery. If this is not done, loss of filtration with severe hypopermeability (type II) may develop due to multiple adhesions or to the encapsulating process.