Encapsulating Peritoneal Sclerosis

Encapsulating peritoneal sclerosis is a rare but serious complication of peritoneal dialysis. It has a mortality of more than 30%.

Our Case

Elderly male with longstanding history of renal failure, status post failed renal transplant, and history of long standing peritoneal dialysis.

Findings are consistent with encapsulating peritoneal sclerosis characterized by thickening of the peritoneum, ascites under pressure with deformity of the posterior aspect of the liver, compression of bowel loops so they do not consistently rise to the anterior abdominal wall, and suggestion of cocoon formation of some of the bowel loops and peritoneal fat.  There is no evidence of obstruction and no findings of omental metastases

 

Radiopaedia

Case courtesy of Dr Vitalii Rogalskyi, Radiopaedia.org, rID: 66354
Case courtesy of Dr Vitalii Rogalskyi, Radiopaedia.org, rID: 66354
Case courtesy of Dr Vitalii Rogalskyi, Radiopaedia.org, rID: 66354

 

ENCAPSULATING PERITONEAL SCLEROSIS
Kawanishi et al Successful surgical management of encapsulating peritoneal sclerosis Journal of the International Society for peritoneal Dialysis
Courtesy PDI connect.com
Zia Moinuddin, et al  Encapsulating peritoneal sclerosis—a rare but devastating peritoneal disease
Frontiers in Physiol. 2014; 5: 470.
Published online 2015 Jan 5.

aka

abdominal cocoon

sclerosing peritonitis, encapsulating peritonitis, and peritonitis chronica fibrosa incapsulata.

Cause

Dialysis fluid is hyperosmotic, hyperglycemic, and acidic

• Autoimmune diseases
• Sarcoidosis TB
• Peritoneal and intra-abdominal malignancies
• Chronic peritoneal ascites
• Intra-peritoneal chemotherapy
• Intraperitoneal exposure to particulate matter or disinfectant
• Abdominal surgery
• Endometriosis
• Intra-peritoneal infections (tuberculosis)
• Beta-blocker administration

Presentation

 low-grade fever,

ascites with negative culture,

elevated C-reactive protein level

poor response to antibacterial therapy.

Stages

Stage 1- Asymptomatic with mild ascites and no inflammation.
Stage 2- Inflammatory stage: Patients are symptomatic with nausea and diarrhea consistent with partial encapsulation of the bowel and intestinal swelling. Mild inflammation with fibrin exudation is present.
Stage 3- Encapsulation: Symptoms of bowel obstruction due to the formation of the fibrous cocoon causing encapsulation. It can be associated with mild to severe inflammation.
Stage 4- Chronic stage of ileus: Patients have absolute bowel obstruction caused by thickening of the encapsulating fibrous cocoon. There is little, if any, inflammation at this stage.

 

 

References and Links

Radiopaedia