Abstract: PUB149
Encapsulating Peritoneal Sclerosis (EPS): Initial Presentation as Incidental Finding of Peritoneal Calcifications During Laparoscopic PD Catheter Placement
Session Information
Category: Dialysis
- 703 Dialysis: Peritoneal Dialysis
Authors
- Xu, Zhi, University of New Mexico Hospital, Albuquerque, New Mexico, United States
- Dawood, Moiz, University of New Mexico Hospital, Albuquerque, New Mexico, United States
Introduction
EPS is a rare but devastating complication of longterm peritoneal dialysis (PD) characterized by inflammatory and fibrotic peritoneal capsule that entraps the bowel loops.
Case Description
A 64 year-old woman with end-stage kidney disease who had been on PD for 13 years was referred to a surgeon for a new PD catheter placement after temporary transfer to hemodialysis (HD) due to refractory peritonitis. During the laparoscopic procedure, the surgeon noticed many plaques of “sclerosing reactions” on her mesentery. No adhesions were observed. In light of the patient’s long period of 13 years on PD, we were concerned about EPS and promptly transitioned her to HD. Up to this point, patient had done well on PD. She had effective ultrafiltration. She was a low transporter. Six months after her transition to HD, she was admitted to the hospital with anorexia and weight loss. She was found to have small bowel obstruction. She underwent lysis of adhesions and was noted to have dense fibrosis of the visceral peritoneum. She declined steadily and withdrew from care.
Discussion
As our case demonstrates, early diagnosis of EPS requires a high degree of vigilance. There are no specific tests to diagnose EPS. The early phase of EPS maybe indicated by appearance of ultrafiltration failure with change to high transporter status. Unfortunately EPS is usually diagnosed in the later progressive stage when intestinal obstruction becomes evident. As EPS becomes apparent, evidence supporting its diagnosis includes radiologic findings of loculated ascites and calcifications along the peritoneum and small bowel loops. Time on PD ( > 5 years) is the only consistent predictor for the occurrence of EPS.
The diagnosis of EPS mandates the immediate transition from PD to HD. There is no consensus regarding optimal treatment, which may include surgical lysis of intestinal adhesions, nutritional support, and immunosuppressive therapy with prednisolone and or tamoxifen.