Sclerosing peritonitis and peritoneal pseudocyst: a rare cause of surgical acute abdomen in peritoneal dialysis patients—diagnostic and therapeutic insights

Peritoneal pseudocysts are benign, fluid-filled structures that arise from the accumulation of intra-abdominal fluid, which would typically be reabsorbed by the peritoneum. These pseudocysts form when peritoneal integrity is disrupted by adhesions, often secondary to trauma, surgery, or infection. While intraperitoneal pseudocysts are rare, they are most frequently associated with inflammatory processes, including ventriculoperitoneal shunt complications, catheter-related infections. Sclerosing peritonitis (SP), a rare but serious complication of long-term continuous ambulatory peritoneal dialysis, is characterized by marked thickening of the peritoneal membranes. Histologically, these membranes consist of dense fibrotic connective tissue infiltrated by mononuclear and polymorphonuclear cells. The pathogenesis of SP-associated pseudocysts is thought to involve low-grade infection or localized chronic inflammation. A 59-year-old male on peritoneal dialysis presented to the emergency department with chronic abdominal pain. Computed tomography imaging revealed a large peritoneal pseudocyst. During exploratory midline laparotomy, the pseudocyst was successfully evacuated, and the peritoneal dialysis catheter was removed.