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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