A Case of Hemodialysis Patients with Encapsulating Peritoneal Sclerosis (EPS)-like Finding

Abstract

Encapsulating peritoneal sclerosis (EPS) is recognized as a serious complication of peritoneal dialysis (PD). Involvement of the inflammation is indispensable as the EPS emission factor. We experienced the surgery of the EPS‐like case that emits it to the hemodialysis (HD) patient without the PD. Patient: In November 1996 the patients, a 47‐year old male developed end‐stage renal failure due to chronic nephritis and started HD. Before and during HD, he complicated alcohol liver cirrhosis with ascites. In September 2001 he had intestinal obstructive symptoms and recovered with repeated puncture and drainage of ascites. Abdominal CT examination revealed the intestine oppression by the ascites with thick tunic formation. At May 2002, he underwent a laparotomy. Thick capsules formed surroundings to the ascites. This capsules covered parietal peritoneum and intestine surface and oppressed the intestine. The total ablation of small intestine was succeeded. Ascites examinations IL‐6 20,350 pg/mL FDP 80 micro‐g/mL TAT 1090 micro‐g/L, was suspected to conjecture the involvement of inflammation and coagulate‐fibrinolysis. Histology of peritoneum showed absence of mesothelium but not fibrosis and sclerosis. Discussion: EPS is caused by the inflammation on the deteriorated peritoneum, resulting in encapsulation after the accumulation of inflammatory products such as fibrin. Even if there is not the peritoneum deterioration, chronic inflammation and stimulation that continues for long‐time causing EPS‐like findings with encapsulation. The encapsulating ileus findings irrespective of the peritoneum deterioration should call with encapsulated peritonitis (EP).