Encapsulating peritoneal sclerosis

Published: 04/04/2012

Authors: Baker CR, Kessaris N and Oliveira D

A 32-year-old man underwent cadaveric renal transplant after 10 years on continuous ambulatory peritoneal dialysis. At surgery, biopsy of his peritoneum revealed fibrosis and dystrophic calcification. Six months later, he was admitted with nausea, vomiting and abdominal distension. CT revealed extensive calcification of the peritoneum and bowel surfaces. Paracentesis drained 6 litres of bloody ascites. Encapsulating peritoneal sclerosis is a rare, but deadly complication of peritoneal dialysis. It is characterised by sclerosis and fibrosis of peritoneal surfaces, resulting in insidious partial or complete bowel obstruction with, or without haemorrhagic ascites. Treatment options are limited, with high mortality (>50%) due to malnutrition. Corticosteroids, tamoxifen, and surgical adhesionolysis have been used in small case series.