Sclerosing peritonitis

Peritonitis caused by practolol was first recognized by Brown et al. (1974). Patients presented with a history of nausea, vomiting, abdominal pain, steatorrhea, loss of weight, and in some cases an abdominal mass. 

The average length of treatment with practolol prior to the development of the first symptom of sclerosing peritonitis was about 34 months (Nicholls 1978). A disturbing feature, however, and one which eventually led to withdrawal of the drug, was that the symptoms had been reported up to 18 months after cessation of treatment (Allan and Cade 1975 Halley and Goodman 1975). About 50 patients with this particular feature of the syndrome are known to the CSM, either in conjunction with other aspects of the syndrome, or as the main one. 

Laparotomy findings showed that the peritoneal cavity was obliterated with gross thickening and contraction of the parietal and visceral layers of the peritoneum. The small bowel was encased in a rigid tube and usually shortened, but the adverse effect stopped at the ileocecal valve. 

Peritoneal biopsies showed a nonspecific inflammatory reaction with fibrous tissue comprising layers of coarse collagen bundles interspersed with the visceral peritoneum. 

In Wright s 27 patients, 5 had recurrent ulceration of the oral and nasal mucosa, which stopped when practolol therapy was discontinued. Although there is no argument that this is part of the oculomucocutaneous syndrome, it is not a major component. 

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Practolol (Figure 8.13) was the prototype cardioselective p-adrenoceptor blocking agent. Selectivity was achieved by substitution in the para position with an acetyl anilino function. The similarity of this drug with those outlined above is obvious. Practolol caused severe skin and eye lesions in some patients which led to its withdrawal from the market [6]. These lesions manifested as a rash, hyperkeratosis, scarring, even perforation of the cornea and development of a fibrovascular mass in the conjunctiva, and sclerosing peritonitis. Some evidence is available that the drug is oxidatively metabolized to a reactive product that binds irreversibly to tissue pro-... 

Communication with the profession was at first maintained by continuing (until January 1985) the Adverse Reaction Series leaflets started by CSD, and later by a regularly published bulletin on Current Problems . The first issue of Current Problems in September 1975 led with the adverse oculo-cutaneous effects and sclerosing peritonitis associated with p-adrenergic receptor blocking agents and also included items on loss of consciousness associated with prazosin and on the risks of anti-inflammatory agents and asthma. 

Eye damage and sclerosing peritonitis with Practolol and perforated intestines with nonsteroid anti-inflammatory drugs such as indomethacin and benzoxaprofen. 

Sclerosing peritonitis was described as part of the practo-lol syndrome (219-221), and it can also occur with other beta-adrenoceptor antagonists (222,223). 

Eltringham WK, Espiner HJ, Windsor CW, Griffiths DA, Davies JD, Baddeley H, Read AE, Blunt RJ. Sclerosing peritonitis due to practolol a report on 9 cases and their surgical management. Br J Surg 1977 64(4) 229-35. 

Nillson BV, Pederson KG. Sclerosing peritonitis associated with atenolol. BMJ (Clin Res Ed) 1985 290 518. 

Sclerosing peritoneal disease occurred in peritoneal dialysis patients in whom the tubing connection had been disinfected with chlorhexidine (32-34) 214 cases were... 

Junor BJ, Briggs JD, Forwell MA, et al. Sclerosing peritonitis—the contribution of chlorhexidine in alcohol. Periton Dial Bull 1985 5 101. 

Oules R, Challah S, Brunner FP. Case-control study to determine the cause of sclerosing peritoneal disease. Nephrol Dial Transplant 1988 3(l) 66-9. 

Lo WK, Chan KT, Leung AC, Pang SW, Tse CY. Sclerosing peritonitis complicating prolonged use of chlorhexidine in alcohol in the connection procedure for continuous ambulatory peritoneal dialysis. Peril Dial Int 1991 ll(2) 166-72. 

Majumdar A, Lipkin GW, Eliott TS, Wheeler DC. Vancomycin-dependent enterococci in a uraemic patient with sclerosing peritonitis. Nephrol Dial Transplant 1999 14(3) 765-7. 

Baxter-Smith DC, Monypenny IJ, Darricott NJ (1978) Sclerosing peritonitis in patient on timolol (letter). Lancet 2 149... 

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