A Case of Isolated Small Intestinal Wall Calcification on Patient with Continuous Ambulatory Peritoneal Dialysis

Jeong Im Choi; Dong Soo Han; Hae Su Kim; Yu Hwa Lee; Hyun Soo Kim; Seong Eun Ahn; Yong Cheol Jeon; Joo Hark Yi

doi:10.4166/kjg.2013.62.1.55

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Choi, Han, Kim, Lee, Kim, Ahn, Jeon, and Yi: A Case of Isolated Small Intestinal Wall Calcification on Patient with Continuous Ambulatory Peritoneal Dialysis

Case Report

Korean J Gastroenterol 2013;62(1):55-58.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.1.55

A Case of Isolated Small Intestinal Wall Calcification on Patient with Continuous Ambulatory Peritoneal Dialysis

Jeong Im Choi, Dong Soo Han, Hae Su Kim, Yu Hwa Lee, Hyun Soo Kim, Seong Eun Ahn, Yong Cheol Jeon, Joo Hark Yi

Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea

Correspondence to: Dong Soo Han, Department of Internal Medicine, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471-701, Korea. Tel: +82-31-560-2225, Fax: +82-31-555-2998, E-mail: hands@hanyang.ac.kr

Received 14 September 201220 November 2012 Accepted 30 November 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The metastatic calcification is defined as the deposition of calcium salt in normal tissue with an abnormal serum biochemical environment, such as chronic kidney disease, hyperparathyroidism, and hypercalcemia related with malignancy. Although the metastatic calcification can develop in any organs and tissues, presenting its symptoms and complications are rare. Thus a few cases have been reported. This case shows the metastatic calcification of the small intestine without any peritoneal and mesenteric vascular calcification which was early diagnosed by computed tomography and mesenteric angiography in a patient with abdominal pain, receiving continuous ambulatory peritoneal dialysis due to end stage renal disease. The clinician should early consider the metastatic calcification as differential diagnosis when unidentified calcifications are noted in simple abdominal X-ray such as in the present case, and promptly confirm it by using appropriate diagnostic tests in order to prevent its complications and progression.

Keywords: Calcification, ectopic, Small intestine, Continuous ambulatory peritoneal dialysis

References

1. Ketteler M, Rothe H, Krüger T, Biggar PH, Schlieper G. Mechanisms and treatment of extraosseous calcification in chronic kidney disease. Nat Rev Nephrol. 2011; 7:509–516.

2. Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium × phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis. 1998; 31:607–617.

3. Salem MM. Hyperparathyroidism in the hemodialysis population: a survey of 612 patients. Am J Kidney Dis. 1997; 29:862–865.

4. Li YJ, Tian YC, Chen YC, et al. Fulminant pulmonary calciphylaxis and metastatic calcification causing acute respiratory failure in a uremic patient. Am J Kidney Dis. 2006; 47:e47–e53.

5. Cha I, Cho E, Yoon K, et al. A case of peritonitis induced by small bowel calcification and microperforation: sustained secondary hyperparathyroidism in a patient with continuous peritoneal dialysis. Korean J Nephrol. 2010; 29:529–534.

6. Alfrey AC. The role of abnormal phosphorus metabolism in the progression of chronic kidney disease and metastatic calcification. Kidney Int Suppl. 2004; (90):S13–S17.

7. Gorospe M, Fadare O. Gastric mucosal calcinosis: clinicopathologic considerations. Adv Anat Pathol. 2007; 14:224–228.

8. Moe SM, Duan D, Doehle BP, O'Neill KD, Chen NX. Uremia induces the osteoblast differentiation factor Cbfa1 in human blood vessels. Kidney Int. 2003; 63:1003–1011.

9. Cozzolino M, Mazzaferro S, Pugliese F, Brancaccio D. Vascular calcification and uremia: what do we know? Am J Nephrol. 2008; 28:339–346.

10. Chen NX, Duan D, O'Neill KD, Moe SM. High glucose increases the expression of Cbfa1 and BMP-2 and enhances the calcification of vascular smooth muscle cells. Nephrol Dial Transplant. 2006; 21:3435–3442.

11. Ubara Y, Katori H, Tagami T, et al. Severe ectopic calcification of the intestinal wall in a patient on long-term continuous ambulatory peritoneal dialysis therapy. Am J Kidney Dis. 2000; 35:761–766.

12. Poultsidi A, Liakopoulos V, Eleftheriadis T, Zarogiannis S, Bouchlariotou S, Stefanidis I. Gross calcification of the small bowel in a continuous ambulatory peritoneal dialysis patient with sclerosing peritonitis. Adv Perit Dial. 2006; 22:104–107.

13. Morris-Stiff GJ, Bowrey DJ, Balaji V, Jurewicz WA. Calcification of the small bowel in renal hyperparathyroidism. J R Soc Med. 1998; 91:430–431.

14. Kawanishi H, Kawaguchi Y, Fukui H, et al. Encapsulating peritoneal sclerosis in Japan: a prospective, controlled, multicenter study. Am J Kidney Dis. 2004; 44:729–737.

15. Kawaguchi Y, Kawanishi H, Mujais S, Topley N, Oreopoulos DG. Encapsulating peritoneal sclerosis: definition, etiology, diagnosis, and treatment. International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis. Perit Dial Int. 2000; 20(Suppl 4):S43–S55.

16. Song JH, Kim JI, Jung JH, et al. A case of phlebosclerotic colitis in a hemodialysis patient. Korean J Gastroenterol. 2012; 59:40–43.

Fig. 1.

The changes of intact parathyroid hormone (iPTH) level and calcium-phosphorous product (Ca×PO₄).

Fig. 2.

Plain abdominal X-ray showed calcification (arrows) in the left upper quadrant (B) although it had not shown in previous plain X-ray (A).

Fig. 3.

Abdominal CT scan showed linear calcification along jejunal wall (arrows). Also, aortic calcification was also noted (arrowheads).

Fig. 4.

Superior mesenteric artery angiography of arterial phase (A) and portal phase (B). There were no abnormal findings on both arteries and veins. Mural calcification on small bowel was noted.

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