次發性副甲狀腺功能亢進的腹膜透析病人以金黃色條紋小腸表現之鈣化性腹膜炎：個案報告

Gold-streaked Small Intestine as Calcifying Peritonitis in a Peritoneal Dialysis Patient with Secondary Hyperparathyroidism

尿毒症病患常合併電解質異常的狀況。部分的電解質可以透過飲食控制及透析來控制，但是有些電解質，尤其是鈣、磷，則相當困難。許多末期腎病患者即使沒有高血鈣的狀況，仍會在不同的器官發生異位性鈣化。實際上，高血磷及鈣磷乘積上升卻更易在末期腎病患者身上引起異位性鈣化，進而導致血管鈣化及繼發的血管病變。末期腎病患者若有高血磷的，會導致次發性副甲狀腺亢進，也就是所謂的腎性副甲狀腺亢進。因此，次發性副甲狀腺亢進可能是引起異味性鈣化的主要因素。在此，我們提出一位接受腹膜透析十年的末期腎病女性病患，在大腸癌的術前檢查中，意外發現腹部X光及腹部電腦斷層的影像都呈現廣泛性腸壁鈣化，但是病患卻沒有任何腸道症狀。手術中也不預期地發現腸壁呈現金黃色條紋。這個表現不同於腹膜透析病人少見且嚴重的包囊性腹膜硬化症的型態，我們把這種形式的腹膜鈣化歸類於鈣化性腹膜炎。雖然臨床上對於鈣化性腹膜炎和包囊性腹膜硬化症的因果關係尚不清楚，一旦腹膜透析的病人發現有鈣化性腹膜炎時，最好還是儘早改為血液透析，以預防更嚴重的併發症產生。

 

Electrolyte imbalance is not uncommon in uremic patients. Diet control and dialysis per se are able to control some but not all, especially calcium (Ca) and phosphate (P) imbalance. Many patients with end-stage renal disease (ESRD) have ectopic calcification in different organs even without hypercalcemia. Instead, hyperphosphatemia and elevated Ca ´ P product predispose patients to ectopic calcifications such as vascular calcification and subsequent vascular events. Hyperphosphatemia observed in ESRD patients could lead to secondary hyperparathyroidism, or the so-called renal hyperparathyroidism. Therefore, hyperphosphatemia and secondary hyperparathyroidism might be the main factor that leads to ectopic ossification. Herein, we present a female patient with ESRD who underwent continuous ambulatory peritoneal dialysis (CAPD) for 10 years. In the preoperative survey for colon cancer, both abdominal radiography and abdominal computed tomography images identified diffuse bowel wall calcification, but the patient had no gastrointestinal tract symptoms. Unexpectedly, gold-streaked small intestine was found during the operation, which was compatible with the pattern of small intestine calcification in the imaging study. This presentation was different from the morphology of encapsulating peritoneal sclerosis (EPS), an unusual complication in PD patients. This pattern of peritoneal calcification is referred to as calcifying peritonitis. Although the causal relationship between calcifying peritonitis and EPS is unclear, PD patients might better be switched to hemodialysis as soon as possible once peritoneal calcification is noticed.