Encapsulating Peritoneal Sclerosis: A Case Report and Literature Review

Abstract

Patient: Male, 26-year-old Final Diagnosis: Encapsulating peritoneal dialysis Symptoms: Abdominal distension • abdominal pain • constipation • vomiting Medication:— Clinical Procedure: — Specialty: Nephrology • Surgery • Transplantology Objective: Rare disease Background: Encapsulating peritoneal sclerosis (EPS) is a rare, life-threatening, and serious complication of long-term peritoneal dialysis (PD). No evidence-based management strategy has been established until now. Surgical management, including enterolysis and excision of the sclerotic and obstructing adhesions, should be considered as soon as conservative management fails to work. We report a case of EPS soon after transplantation in a patient with end-stage kidney disease who had been on long-term PD. Case Report: A 26-year-old man had been found to have advanced chronic kidney disease secondary to glomerulonephritis on pre-employment investigation. He was on continuous ambulatory PD for 5 years, after which he underwent a living donor renal transplant from his full HLA-matched sibling. He did well postoperatively, with excellent graft function. One month after transplantation, he repeatedly presented to our Emergency Department with signs and symptoms of complete small-bowel obstruction. Computed tomography of the abdomen showed features of small-bowel obstruction secondary to interloop adhesions. The patient was initially managed conservatively; however, as his condition continued to deteriorate, an exploratory laparotomy was carried out. Operative findings were suggestive of early EPS localized to the terminal ileum. Total enterolysis along with peritonectomy was performed along with resection of the diseased and obstructing terminal ileum. The patient did well, and he was discharged home day 10 postoperatively. Conclusions: EPS remains a serious and fatal complication of long-term PD. Early definitive diagnosis, treatment, and ultimately surgical intervention may be required to prevent the morbidity and mortality associated with this condition.

Encapsulating Peritoneal Sclerosis in Systemic Lupus Erythematosus, Rheumatoid Arthritis, and Systemic Sclerosis

“…Encapsulating peritoneal sclerosis (EPS) is a rare clinical syndrome characterized by an inflammatory fibrocollagenous membrane encasing the small and large intestines, resulting in recurrent intestinal obstruction (1)(2)(3). EPS often occurs as refractory ascites retention due to chronic peritonitis (2)(3)(4)(5)(6).…”

“…Abdominal computed tomography is useful for diagnosing EPS but is often inadequate. The most sensitive and specific method for EPS is laparoscopy or laparotomy, which can visualize the peritoneal thickening that encloses the bow-els (1)(2)(3). In addition, a histopathological diagnosis using a peritoneal biopsy has also been found to be useful (1)(2)(3).…”

“…The most sensitive and specific method for EPS is laparoscopy or laparotomy, which can visualize the peritoneal thickening that encloses the bow-els (1)(2)(3). In addition, a histopathological diagnosis using a peritoneal biopsy has also been found to be useful (1)(2)(3). While there is no established therapy for EPS, nutritional support, antimicrobials, corticosteroids, and surgical intervention have been widely used for many years (1)(2)(3).…”

“…In addition, a histopathological diagnosis using a peritoneal biopsy has also been found to be useful (1)(2)(3). While there is no established therapy for EPS, nutritional support, antimicrobials, corticosteroids, and surgical intervention have been widely used for many years (1)(2)(3).…”

Spectrum of Complications of Patients with Chronic Kidney Disease on Maintenance Continuous Ambulatory Peritoneal Dialysis: An Experience of Tertiary Nephrology Center in Najaf City-Iraq

“…While, the non-infectious complications include, dysfunction of catheter, catheter obstruction or poor drainage, edema or leakage of dialysate subcutaneously or as a peritoneal-pleural fistula, peritoneal herniation, intra-abdominal adhesions abdominal wall weakens, and sclerosing encapsulating peritonitis in addition to hydrothorax [19], [29], [30].…”