Encapsulating peritoneal sclerosis as a late complication of peritoneal dialysis

Abstract

Introduction: Encapsulating peritoneal sclerosis (EPS) is a rare cause of intestinal obstruction which is characterized by fibrotic encapsulation of the bowel. Although its pathogenesis is still not clear, many etiological factors have been stated.

Presentation of case: In this report, we present a 26-year old woman with peritoneal dialysis related EPS. Because of the unresolving intestinal obstructive symptoms, she underwent surgical intervention in which the thick dense whitish membranous sac was excised from the surrounding intestine along with adhesiolysis. She recovered uneventfully. She is symptom-free on the eight months of follow-up.

Discussion: EPS should be born in mind as a complication of the long term peritoneal dialysis in patients with progressive obstructive ileus and recurrent peritonitis. Its treatment either medically or surgically varies depending on the stage of this entity.

Conclusion: Early identification of EPS is important in order to achieve better prognosis.

Keywords: Abdominal cocoon; Encapsulating peritoneal sclerosis; Peritoneal sclerosis.

Fig. 1

Abdominal tomography scans reveal diffuse mild thickening and contrast enhancement of the peritoneum along with massive ascites. Retroperitoneal calcified mass lesion compatible with ex-renal transplant is seen in the left lower quadrant.

Fig. 2

Intestinal loops localized in the center of the abdomen due to massive ascites have thickened and edematous walls.

Fig. 3

Membrane composed of fibrous tissue and scattered mononuclear inflammatory cells on the pathologic exam with HEx200 are seen.