Monday, August 6, 2012


Encapsulating Peritoneal Sclerosis (EPS), the most serious complication of peritoneal dialysis (PD) was recognized soon after PD was introduced. It is characterized by extensive intraperitoneal fibrosis and encasement of bowel loops. It is typically characterized by loss of ultrafiltration, resulting in fluid retention and edema. 

From the viewpoint of clinical presentation, it progresses to various stages from early phase of faint inflammation to fibrin exudates and active inflammation. This is followed by formation of encapsulating membrane and sustained inflammation. Finally, thickening occurs and there is moderate inflammation.

Development of EPS is associated with three main clinical factors: prolonged duration of PD, persistent
Or frequent bacterial or fungal peritonitis, and membrane failure. The cumulative duration of exposure to PD fluids is the dominant risk factor for EPS, but young age and kidney transplantation might also be risk factors
It can be diagnosed by above clinical features and radiologically by a CT scan which my show evidence of: Peritoneal thickening, peritoneal calcification, tethering and cocooning of bowel and small or large bowel obstruction.

Treatment usually consists of corticosteroids. Some case studies have used Tamoxifen. Surgical treatment consisting of surgical lysis of intestinal adhesions and stripping of fibrous cocoon has been indicated if there is recurrent bowel obstruction, failing nutritional status or failure to respond to medical therapy. Increase incidence has been noted after transplantation. Unclear why is that the case.

Good references:

Post by Dr.Divya Monga

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