Long-Term Success with Adhesiolysis in Post-Transplant Encapsulating Peritoneal Sclerosis: A Retrospective Case Series of 4 Patients and Review of the Literature

Oğuz, Ebru Gök; Okyay, Gülay Ulusal; Merhametsiz, Özgür; Ersöz, Sadık; Canbakan, Başol; Aylı, Deniz

doi:10.2169/internalmedicine.55.5461

Cited by 4 publications

(1 citation statement)

References 20 publications

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“…EPS usually develops in the early stage after kidney transplantation, which is supported by the two-hit hypothesis of EPS pathogenesis [8]. Similar to our results, posttransplant EPS shows better prognosis and postoperative outcomes are favorable if renal function is preserved [22,34]. Moreover, clinical resolution of established EPS has been reported after kidney transplantation, possibly due to immunosuppression [35].…”

Section: Discussionsupporting

confidence: 85%

Outcomes of the surgical management of encapsulating peritoneal sclerosis: A case series from a single center in Korea

Ryu

Lee

Koo

et al. 2019

Kidney Res Clin Pract

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BackgroundEncapsulating peritoneal sclerosis (EPS) is a rare but near-fatal complication of peritoneal dialysis (PD). Despite the high mortality rate of EPS, the surgical treatment strategy of severe EPS is yet to be established.MethodsWe retrospectively analyzed outcomes of patients with EPS who underwent enterolysis for intractable EPS at Seoul National University Hospital between 2001 and 2018. EPS was diagnosed based on the clinical symptoms and radiological findings of abdominal computed tomography (CT). CT scans were scored according to an EPS scoring system that assessed peritoneal thickening and calcification as well as bowel thickening, tethering, loculation, and dilatation.ResultsThirteen patients (nine males and four females; age, 48 [29–63] years) underwent enterolysis for severe EPS. PD duration (11 [6–21] years) was not associated with survival. Two patients were newly diagnosed with EPS following kidney transplantation. Five patients died of infectious complications immediately after the surgery. Eight patients survived after the first surgery; however, five of them underwent reoperation but died of persistent infection, fistula formation, or adhesive bowel obstruction. Four young (< 60 years) male patients with relatively low CT scan scores (< 13) survived for > 2 years after the first surgery. Median survival duration from EPS diagnosis was 22 (1.3–184) months and that from the first surgery was 9 (0.3–153) months.ConclusionThe high mortality rate of EPS suggests the importance of appropriate surgical intervention in young symptomatic male EPS patients with relatively low CT scan scores.

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Section: Discussionsupporting

confidence: 85%

Outcomes of the surgical management of encapsulating peritoneal sclerosis: A case series from a single center in Korea

Ryu

Lee

Koo

et al. 2019

Kidney Res Clin Pract

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Encapsulated Peritoneal Sclerosis due to Peritoneal Dialysis: Long-Term Experience Following Surgical Operation

et al. 2022

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Encapsulating Peritoneal Sclerosis: A Case Report and Literature Review

et al. 2020

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Patient: Male, 26-year-old Final Diagnosis: Encapsulating peritoneal dialysis Symptoms: Abdominal distension • abdominal pain • constipation • vomiting Medication:— Clinical Procedure: — Specialty: Nephrology • Surgery • Transplantology Objective: Rare disease Background: Encapsulating peritoneal sclerosis (EPS) is a rare, life-threatening, and serious complication of long-term peritoneal dialysis (PD). No evidence-based management strategy has been established until now. Surgical management, including enterolysis and excision of the sclerotic and obstructing adhesions, should be considered as soon as conservative management fails to work. We report a case of EPS soon after transplantation in a patient with end-stage kidney disease who had been on long-term PD. Case Report: A 26-year-old man had been found to have advanced chronic kidney disease secondary to glomerulonephritis on pre-employment investigation. He was on continuous ambulatory PD for 5 years, after which he underwent a living donor renal transplant from his full HLA-matched sibling. He did well postoperatively, with excellent graft function. One month after transplantation, he repeatedly presented to our Emergency Department with signs and symptoms of complete small-bowel obstruction. Computed tomography of the abdomen showed features of small-bowel obstruction secondary to interloop adhesions. The patient was initially managed conservatively; however, as his condition continued to deteriorate, an exploratory laparotomy was carried out. Operative findings were suggestive of early EPS localized to the terminal ileum. Total enterolysis along with peritonectomy was performed along with resection of the diseased and obstructing terminal ileum. The patient did well, and he was discharged home day 10 postoperatively. Conclusions: EPS remains a serious and fatal complication of long-term PD. Early definitive diagnosis, treatment, and ultimately surgical intervention may be required to prevent the morbidity and mortality associated with this condition.

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Long-Term Success with Adhesiolysis in Post-Transplant Encapsulating Peritoneal Sclerosis: A Retrospective Case Series of 4 Patients and Review of the Literature

Cited by 4 publications

References 20 publications

Outcomes of the surgical management of encapsulating peritoneal sclerosis: A case series from a single center in Korea

Outcomes of the surgical management of encapsulating peritoneal sclerosis: A case series from a single center in Korea

Encapsulated Peritoneal Sclerosis due to Peritoneal Dialysis: Long-Term Experience Following Surgical Operation

Encapsulating Peritoneal Sclerosis: A Case Report and Literature Review

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