1.Encapsulating peritoneal sclerosis: The abdominal cocoon
Rizna Abdul CADER ; Rozita MOHD ; Syahrizan SAMSUDDIN ; Halim GAFOR ; Ema JULIATY ; Norella CT. KONG
Brunei International Medical Journal 2013;9(1):56-62
Encapsulating Peritoneal Sclerosis (EPS) is a rare but serious complication of long-term peritoneal dial-
ysis (PD) that is associated with a high morbidity and mortality. EPS has been previously referred to as
sclerosing peritonitis, sclerosing encapsulating peritonitis or the ‘abdominal cocoon’. EPS is character-
ised by diffuse thickening and sclerosis of the peritoneal membrane which leads to a decrease in ultra-
filtration, ascites and ultimately partial or complete small bowel obstruction. The aetiology of EPS is
unknown but it has been reported to be closely associated with the duration on PD, recurrent peritoni-
tis, high transporter status and use of high concentration of glucose dialysis solutions. Stopping or
switching from PD seems to be another trigger factor. Several treatment options including oestrogen
and immunosuppressive therapy have been tried, but the mortality remains high at approximately
50%. In some cases, surgery has been attempted but this is associated with high morbidity and mor-
tality. Supportive therapy includes nutritional support with total parenteral nutrition. EPS needs to be
diagnosed early and one has to have a high index of suspicion. We report three cases of EPS in patients
on PD with different presentation of EPS, their treatment and a brief literature review.
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