Review of the Literature and Description of a Case of Sclerosing Encapsulating Peritonitis Requiring Home Parenteral Nutrition

K. C. Fragkos; F. M. Al-Sulttan; R. P. Mookerjee; A. Winstanley; A. Forbes

doi:10.1055/s-0031-1281847

Zeitschrift für Gastroenterologie, Inhaltsverzeichnis

Z Gastroenterol 2011; 49(12): 1543-1548
DOI: 10.1055/s-0031-1281847

Kasuistik

Review of the Literature and Description of a Case of Sclerosing Encapsulating Peritonitis Requiring Home Parenteral Nutrition

Durchsicht der Literatur und Fallbericht eines Patienten mit sklerosierender verkapselnder Peritonitis, der durch parenterale Ernährung zu Hause versorgt wird

K. C. Fragkos^*

¹Centre for Gastroenterology & Nutrition, University College London

,

F. M. Al-Sulttan

²Department of Histopathology, University College London Hospital

,

R. P. Mookerjee

³Institute of Hepatology, University College London

,

A. Winstanley

²Department of Histopathology, University College London Hospital

,

A. Forbes

²Department of Histopathology, University College London Hospital

› Institutsangaben

Abstract

We present a case of a 48 year old HIV patient, who had recurrent episodes of ascites since 2007. His history includes ischaemic heart disease, for which he was treated with atenolol from 2005 to 2007, and Type 2 diabetes; he was later started on propranolol 40 mg twice a day from 2007 for Didanosine-induced portal hypertension. Because of negative cultures and neutrophil count < 250 cells/μL, spontaneous bacterial peritonitis was excluded. However, some low grade-peritoneal irritation cannot be ruled out because his CRP varied from 24 to 258, during 2007 – 2009, without any other obvious inflammatory cause. He was finally diagnosed in July 2009 with sclerosing encapsulating peritonitis (SEP) based on clinical features of intestinal obstruction, histology and imaging, including computed tomography and magnetic resonance imaging. Propranolol was stopped in November 2009. Because of the patient’s severe intestinal obstruction, he was started on parenteral nutrition 2 L/day. Since then, his CRP has returned to normal levels and there is a great improvement of his clinical features. This case demonstrates beta-blockers as a potential cause of SEP, while the presence of some low-grade peritoneal inflammation leading to SEP is also very likely.

Zusammenfassung

Wir präsentieren den Fall eines 48-jährigen HIV-positiven Patienten, der seit 2007 an periodisch auftretendem Aszites leidet. Seine Krankengeschichte beinhaltet zudem eine ischämische Herzerkrankung, die von 2005 – 2007 mit Atenolol behandelt wurde, und Typ-2-Diabetes; später im Jahr 2007 begann man aufgrund einer durch Didanosin herbeigeführten portalen Hypertension (durch Didanosin herbeigeführte Leberzirrhose) ihm 2-mal täglich 40 mg Propanolol zu verabreichen. Aufgrund negativer Blutkulturen und einer Neutrophilenzahl < 250 /μl wurde eine spontan bakterielle Peritonitis ausgeschlossen. Allerdings kann eine leichte peritoneale Irritation nicht ausgeschlossen werden, da sein CRP von 2007 – 2009 ohne jegliche andere offensichtliche Entzündungsursache zwischen 24 und 258 schwankte. Schließlich wurde bei ihm im Juli 2009 eine sklerosierende verkapselnde Peritonitis (SEP) diagnostiziert, basierend auf klinischen Merkmalen eines Darmverschlusses, Histologie und Bildgebung, einschließlich einer Computertomografie und einer Magnetresonanztomografie. Propanolol wurde im November 2009 abgesetzt. Aufgrund des schwerwiegenden Darmverschlusses wurde beim Patienten 2 l/Tag parenterale Ernährung angesetzt. Seitdem befindet sich sein CRP wieder auf normalem Niveau und seine klinischen Merkmale haben sich enorm verbessert. Dieser Fall zeigt, dass Betablocker eine potenzielle Ursache für SEP darstellen, jedoch gleichzeitig nicht ausgeschlossen werden kann, dass das Vorhandensein einer von leichten peritonealen Entzündungen zu einer SEP führt.

Key words

sclerosing encapsulating peritonitis - beta-blockers - ascites - parenteral nutrition

Schlüsselwörter

sklerosierende verkapselnde Peritonitis - betablocker - aszites - parenterale Ernährung

Volltext

Referenzen

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