Peritoneal Calcification Research Articles

Symptomatic Peritoneal Calcification in a Child: Treatment with Tidal Peritoneal Dialysis

To evaluate the ability of tidal peritoneal dialysis to decrease the pain and frequency of hemoperitoneum associated with peritoneal calcification. Prospective case evaluation. The Home Peritoneal Dialysis Unit, Children's Mercy Hospital. Seven-year old male with diffuse peritoneal calcifications, daily abdominal pain, and recurrent hemoperitoneum. Tidal peritoneal dialysis was conducted with an initial fill volume of 45 mL/kg and a tidal inflow volume of 23 mL/kg. The patient also maintained a daytime pass volume of 45 mL/kg. Duration of treatment was 7 months. The patient's abdominal pain resolved 2 days after initiating tidal peritoneal dialysis. No episodes of hemoperitoneum or abdominal pain have occurred for 7 months. Tidal peritoneal dialysis is a unique approach to the achievement of symptomatic relief in the patient with peritoneal calcification.

Sclerosing Peritonitis With Gross Peritoneal Calcification: A Case Report

We report the case of a patient on dialysis for 13 years, including continuous ambulatory peritoneal dialysis (CAPD) for 11 years, who developed sclerosing peritonitis with gross peritoneal calcification. The patient first presented with abdominal pain in January 1990, when peritoneal calcification was detected for the first time. Her symptoms settled spontaneously and 1 year later she presented with acute peritonitis and adynamic ileus. The peritonitis settled with antibiotics and Tenchkoff catheter removal, but the ileus persisted. She was commenced on long-term parenteral nutrition, but never recovered useful bowel function. After 8 weeks of hemodialysis and total parenteral nutrition, a further laparotomy for an acute abdomen showed what appeared to be extensive bowel infarction and peritoneal calcification. She died several days later. Of significance, peritoneal calcification was first noted on x-ray and computed tomography (CT) scan while the patient was still largely asymptomatic and before peritoneal ultrafiltration capacity was significantly impaired. Unlike other reported cases of calcifying peritonitis, sclerosing peritonitis was present and calcification was far more extensive. It was not associated with factors such as frequent infective peritonitis or acetate dialysate. Calciphylaxis was not present nor was there any abnormality of calcium-phosphate metabolism. The outcome of this case suggests that patients with recurrent or persistent bowel symptoms on long-term CAPD should have early abdominal x-ray or CT scanning to exclude sclerosing peritonitis or bowel calcification. If present, consideration should be given to transferring the patient to another therapeutic dialysis modality if possible.

The imaging diagnosis of sclerosing peritonitis (SP) following continuous ambulatory peritoneal dialysis (CAPD)

Sclerosing peritonitis is a serious complication of CAPD characterised by thickened peritoneal membranes which lead to decreased ultrafiltration and intestinal obstruction. The roentgenographic signs of SP were analysed in 11 patients who underwent plain x-ray of the abdomen, follow-through examinations of the small bowel, ultrasonography and computed tomography. Results were correlated with the histological degree of SP. Besides the non-specific findings of intestinal obstruction, patients with histologically marked SP had loculated fluid collections, thickening of the bowel wall and/or peritoneum, peritoneal calcifications and thickened peritoneal membranes. Due to the fact that postoperative complications often occur in patients with SP, detection of the radiological signs should lead to cautious surgical interventions and changeover to haemodialysis.

Meconium per vaginam secondary to ileal atresia and meconium peritonitis

A neonate was referred for an abdominal mass and passing meconium per vaginam. The anorectum was normal. Roentgenograms revealed a small-bowel obstruction and hypogastric peritoneal calcifications. Findings at celiotomy were: ileal atresia, meconium peritonitis, and two meconium-filled pseudocysts draining through the female genital tract. Excision of the inflammatory masses, resection of the atretic segment, and primary ileoileostomy were followed by an uneventful recovery. Only two similar cases, both fatal, are reported in the English literature. Meconium peritonitis should be considered in the neonate passing meconium per vaginam.

Peritoneal Calcification in a Peritoneal Dialysis Patient: A Case Report

A case of peritoneal calcification in a 44-year-old female treated with peritoneal dialysis for 13 years is reported. The patient, who had secondary hyperparathyroidism and had suffered repeated episodes of catheter-related peritonitis, presented with intraperitoneal bleeding and underwent laparotomy and excision of some of the calcified peritoneal plaques. She remains well on peritoneal dialysis 1 year later with occasional mild intraperitoneal bleeding and reduced peritoneal filtration.

Fetal urethral obstruction: US evaluation.

To further elucidate antenatal sonographic features of fetal urethral obstruction and attempt to determine which features might predict subsequent outcome, 40 in utero cases were reviewed. All fetuses had dilated urinary bladders and/or thickened bladder walls; in 47.5% of fetuses a dilated posterior urethra was seen. Only 15 fetuses (37.5%) survived the neonatal period. Survivors tended to present later in gestation than nonsurvivors. Poor prognostic indicators included oligohydramnios (20 of 21 subsequently died), absence of caliectasis (20 of 24 died), a large amount of urine ascites (five of six died), and dystrophic bladder wall or peritoneal calcification (five of five subsequently died). Conversely, 14 of 19 (74%) fetuses without definite oligohydramnios survived the neonatal period.

Demonstration of Transient Fetal Ascites by Ultrasound in a Patient with Peritoneal Calcification of Meconium Peritonitis

Demonstration of Transient Fetal Ascites by Ultrasound in a Patient with Peritoneal Calcification of Meconium Peritonitis

Intestinal perforation in newborn following intrauterine meconium peritonitis

A newborn infant, who had suffered intrauterine perforation and had developed peritoneal calcification, showed no sign of pneumoperitoneum on the first radiograph taken 3 hours after delivery. At that time air was present in the stomach only. Subsequently pneumoperitoneum developed as air passed down the gut to the point of perforation. Thus, the absence of pneumoperitoneum on a radiograph taken very early in life does not exclude an intestinal perforation.

Unusual aspects of urine ascites.

Urine ascites usually presents at birth or shortly thereafter and is associated with a high overall mortality rate. Posterior urethral valves are the most common obstructive lesions. Prompt recognition is vital if the survival rate is to be improved. Two unusual cases of urine ascites are presented. A stillborn premature infant with imperforate anus and massive ascites showed radiologic evidence of peritoneal calcification. A prepartum diagnosis could have been made from the radiographs of the maternal abdomen. The second case is unique in the presentation of urine ascites caused by a presacral neuroblastoma that produced bladder outlet obstruction and perforation.