腹膜透析から血液透析に移行後に発症した硬化性腹膜炎の1例  [in Japanese] Sclerosing peritonitis in a patient undergoing hemodialysis after conversion from continuous ambulatory peritoneal dialysis.  [in Japanese]

Access this Article

Author(s)

Abstract

症例は60歳, 男性. 1987年11月, 慢性糸球体腎炎による慢性腎不全のため腹膜透析 (CAPD) に導入された. CAPD施行中に腹膜炎を4回繰り返した. 1994年4月, CAPDの効率低下によると思われる全身浮腫, 意識障害を呈したため血液透析 (HD) に変更, 症状は改善した. 同年10月, 腹痛, 腹部膨満感が出現し持続した. 1995年1月より嘔吐を繰り返すようになり, 同年1月13日, 当院に入院した. 腹部は膨隆し波動を触知したが, その他に特記すべき異常所見を認めなかった. 腹部の単純X線, CTではニボー形成, 著明な腹水, 腹膜の肥厚を伴う一塊となった腸管がみられた. 腹水は血性, 浸出性で細胞診はclass IIであった. 硬化性腹膜炎と診断し, 3か月に亘り禁食, 高カロリー輸液を続けたが, 次第に全身状態が悪化し死亡した. 本症の発生頻度は低いが, 栄養状態の不良より死亡する確率は高い. 長期に亘るCAPDの合併症として本症は再認識されるべき疾患である.

A 60-year-old male, who had undergone maintenance hemodialysis (HD) for 6 months after ceasing continuous ambulatory peritoneal dialysis (CAPD), was admitted to Hino City Hospital because of abdominal pain, vomiting and ascites in November, 1995. He had suffered four episodes of bacterial peritonitis during a 7 year course of CAPD management. In April, 1994, CAPD was discontinued with conversion to HD because of anasarca and consciousness disturbance. On admission, he had a distended abdomen, and paracentesis showed bloody exudative ascites without malignant cells. Plain abdominal X-ray showed niveau formation, and computed tomography demonstrated a mass of thickened intestine and a large volume of ascites. Despite hyperalimentation given under a diagnosis of sclerosing peritonitis, his nutrition and general condition deteriorated and he died 3months after initiating intensive treatment.<br>Sclerosing peritonitis is a rare but lifethreatening complication of CAPD. It usually develops in patients undergoing CAPD, but this serious conplication should be considered even after CAPD has been discontinued.

Journal

  • Nihon Toseki Igakkai Zasshi

    Nihon Toseki Igakkai Zasshi 30(1), 75-79, 1997

    The Japanese Society for Dialysis Therapy

Codes

  • NII Article ID (NAID)
    130003721413
  • Text Lang
    JPN
  • ISSN
    1340-3451
  • Data Source
    J-STAGE 
Page Top