most common complication of peritoneal dialysis ENCAPSULATING PERITONEAL SCLEROSIS (EPS)

1. Peritoneal Dialysis
Dr. Mohamed Abbass
Consultant Nephrology
PGDD,CARDIFF,UK 1

2. ENCAPSULATING
PERITONEAL SCLEROSIS
(EPS)
 EPS is an uncommon but serious
complication of long term peritoneal
dialysis  partial or completes intestinal
obstruction.

2

3. ENCAPSULATING
PERITONEAL SCLEROSIS
(EPS)
 The risk factor
 Duration of PD therapy, significant after 5 years and more
after 10 years.
 Onset of PD at young age.
 No association of EPS with the type or number of episodes
of PD peritonitis or with the type or strength of PD solutions
3

4. Pathophysiology
 In a healthy person, the peritoneum is very thin , so the
intestinal loops move easily and food passes through
 In peritoneal dialysis patient, the membrane becomes thick
and fibroses (sclerosed)
 The food is no longer passing through the blocked intestine
which causes abdominal pain, nausea, vomiting and weight
4

5. Pathophysiology
 There are two phases:
 The early inflammatory phase

Vague abdominal discomfort and Bloody effluent

Rapid transport status

Signs of inflammation (erythropoietin- resistant anemia
and elevated CRP).
 Sclerosing phase: the membrane becomes thick and
fibroses (sclerosed) over time till restrict the intestinal
movement and become blocked 5

6. Clinical picture
 Most commonly symptoms occur after quitting PD.
 Symptoms of intestinal obstruction (abdominal pain,
intermittent constipation, vomiting), weight loss,
ascites (which can be haemorrhagic).
 An inflammatory process  raising CRP.
 If patient still on PD; UF failure, Length of time on
PD, Rapid transport status , Severe peritonitis.
6

7. Clinical course
• Severe cases progress rapidly complete
bowel obstruction  severe malnutrition (on
parenteral nutrition) death.
• Moderate cases intermittent course with
nutrition maintained  small amounts frequently
with oral nutritional supplements.
• Mild cases improve all their symptoms over
time and not require any dietary manipulations.
7

8. Diagnosis
 Should be early during inflammatory stage.
 Clinical features:
 HX of change to HD or transplanted after many
years on PD
 Unexplained haemorrhagic ascites
 Unexplained high CRP with abdominal pain
 Unexplained weight loss.
8

9. Diagnosis
 Abdominal CT scan (with contrast) standard
method
 Peritoneal thickening and calcification
 Thickened and Dilated bowel loops with bowel
pulled into center of abdominal cavity (‘fist sign')
 MRI scan has been suggested as a useful tool.
 Abdominal X-ray is not helpful only may show
9

10. 10
Abdominal CT scan from a patient with EPS. Red arrows
indicate thickened parietal peritoneum with calcification.
Green arrows indicate thickened visceral peritoneum forming a
cocoon containing loops of bowel.

11. Treatment
 Drug treatment: in inflammatory phase
 Corticosteroid : moderate dose, duration of
treatment is unclear and should be titrated to the
symptoms.
 Tamoxifen for its antifibrotic effects.
 Sirolimus :no evidence of any benefit.
 Surgery: in sclerosing phase
