Sclerosing encapsulating peritonitis (SEP) in patients on continuous ambulatory peritoneal dialysis: Definition, diagnosis and treatment recommendations, 1996 update

Sclerosing encapsulating peritonitis (SEP) is one of the most serious complications of CAPD. In order to revise the definition, diagnosis and therapeutic strategy of sclerosing encapsulating peritonitis (SEP) in patients on CAPD proposed last year, a consensus meeting on SEP was held in Tokyo, on November 8 and 9, 1996. We made minor changes concerning the definition and treatment of SEP for this year. SEP was defined as a clinical entity which develops persistent, intermittent and/or recurrent clinical symptoms due to adhesive bowel obstruction in patients receiving peritoneal dialysis. Its clinical features are nausea, vomiting and abdominal pain in all patients. In addition, we see malnutrition, weight loss, diarrhea, constipation, slight fever, bloody dialysate, localized or diffuse ascites and decreased bowel movement in some patients with SEP. An abdominal mass consisting of adhesive small bowel is palpable in such patients. Histologically, we observe peritoneal thickening and/or sclerosing peritonitis in peritoneal tissue specimens from patients with SEP. Radiological and ultrasonic evaluations are very helpful for the diagnosis of SEP. The basic strategy for the treatment of SEP is to sustain the rest of the bowel. Long-term intravenous hyperalimentation (IVH) therapy is effective for the treatment of patients with SEP. It was reported that steroid pulse therapy seemed to be effective in five cases from four hospitals. This therapeutic intervention as well as an immunosuppression regimen should be evaluated in a large patient population. We also proposed criteria for discontinuation of CAPD in order to prevent the development of SEP. However, SEP showed heterogeneity in each patient. Therefore, we proposed only a basic strategy for treatment of SEP in this revised version. Further study is needed in this area.