摘要
包囊性腹膜硬化症（encapsulating peritoneal sclerosis）是在接受腹膜透析的病人罕見但是死亡率很高的疾病。本文以一52歲腹膜透析女性患者為例，病人因腹痛、食慾不佳、噁心、嘔吐、及體重減輕初步診斷為腹膜炎，但是臨床症狀在抗生素治療後改善有限，經影像學和腹腔鏡檢查後確診為包囊性腹膜硬化症。在長期接受腹膜透析的病人出現腸阻塞的症狀時需要考慮包囊性腹膜硬化症的可能性，影像學或病理學的檢查可以幫助我們做進一步的鑑別診斷。包囊性腹膜硬化症致病機轉迄今仍不明朗，可能與個體基因及多擊（multiple-hit）作用的結果，最重要的危險因子則是接受腹膜透析時間的長短。治療的方式包括移除腹膜導管並轉成血液透析，給予免疫抑制劑如類固醇（corticosteroid）及泰莫西芬（tamoxifen）等；因嚴重腸阻塞不能進食的病人可以使用腸道或全靜脈營養補充養分，外科腸粘連分離術（enterolysis）也是一個選擇。
並列摘要
Encapsulating peritoneal sclerosis is rare but fatal disease in patients receiving peritoneal dialysis (PD). Here we presented a 52-year-old woman, who had end-stage renal disease under PD, presented with abdomen pain, poor appetite, nausea, vomiting and body weight loss. Her clinical symptoms persisted even after the peritonitis was well controlled, therefore we arranged a serial imaging studies for further survey. Finally the diagnosis of encapsulating peritoneal sclerosis (EPS) was made. By this case, we emphasis that EPS must be considered as a differential diagnosis when patients under PD presented with ileus or uncontrolled peritonitis. The mechanisms of EPS are still unclear. The duration receiving PD is the most important risk factor. Imaging studies can aid in confirming the diagnosis. The therapeutic strategies including shift of the patient from PD to hemodialysis; parenteral nutrition support; and immune-suppression therapy such as steroid and tamoxifen. When the medical treatment is not feasible, surgical enterolysis to free the encapsulated bowel loops is an another choice.
延伸閱讀
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