Sclerosing Peritonitis: A Nosological Entity

Garosi, Guido; Paolo, N. Di; Sacchi, Giovanni; Gaggiotti, E.

doi:10.1177/089686080502503s28

Cited by 39 publications

(26 citation statements)

References 7 publications

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“…Larger studies are needed to evaluate the proposed technique in a wider population affected by EPS. (1). The guidelines seem to favor the use of hemodialysis (HD).…”

Section: Discussionmentioning

confidence: 99%

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Peritoneal Dialysis: The Great Savior during Disasters

et al. 2013

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lead to catastrophic sepsis and require re-exploration, with the potential for extended bowel resection, irreversible stomas, short-gut syndrome, and occasionally, death. We are currently considering a systematic second look 24 hours after the primary procedure. Particular attention should be paid to the terminal ileum, where, in our experience, unnoticed injuries are more likely to occur.The technique we describe here entails a less aggressive approach, which may be better suited to renal patients who frequently have comorbidities and who may be receiving immunosuppressant therapy. Breaking the capsule and releasing the small bowel by gentle pressure is feasible and less time-consuming than total enterolysis and peritonectomy-a surgical technique that is usually associated with significant blood loss and a need for transfusion.Renal patients who are seriously compromised with long-term bowel obstruction and total parenteral nutrition are at much higher risk of developing postoperative complications with poorer long-term outcomes. We would therefore propose early surgical management in this patient group. CONCLUSIONSThe less-aggressive surgical approach of PCC to treat severe forms of EPS has, in our limited experience, attained reasonable long-term clinical results. Those results have encouraged treatment of patients at an early symptomatic stage, with the inclusion of a "second look" policy in future patients. Larger studies are needed to evaluate the proposed technique in a wider population affected by EPS. DISCLOSURESThe authors declare that no potential or actual personal, financial, or political interests are associated with this submission. REFERENCES 1. Garosi G, Di Paolo N, Sacchi G, Gaggiotti E. Sclerosing peritonitis: a nosological entity. Perit Dial Int 2005; 25(Suppl 3):S110-12. 2. Dobbie JW. Pathogenesis of peritoneal fibrosing syndromes (sclerosing peritonitis) in peritoneal dialysis.

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“…Larger studies are needed to evaluate the proposed technique in a wider population affected by EPS. (1). The guidelines seem to favor the use of hemodialysis (HD).…”

Section: Discussionmentioning

confidence: 99%

“…Lack of infrastructure and logistics demand a simple and efficient technique. Expert recommendations support the use of PD only when intermittent HD is not available, when the risk of bleeding is increased with anticoagulation, or when dialysis is required for small children (1).…”

Section: Discussionmentioning

confidence: 99%

Peritoneal Dialysis: The Great Savior during Disasters

et al. 2013

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“…Therefore, studies analysing the histological differences in the peritoneum from EPS and simple sclerosis patients are limited. Of these, only one study performed by Garosi et al ( 2005 ) analyzed both visceral and parietal peritoneum, and Braun and colleagues analyzed only visceral peritoneum (Braun et al, 2012 ) while the remaining studies did not specify the type of peritoneum analyzed (Table 3 ). Garosi and colleagues investigated 180 peritoneal biopsies of PD patients with simple sclerosis and compared morphological findings with those from biopsies of 39 patients with EPS (Garosi et al, 2005 ).…”

Section: Histological Features Of Encapsulating Peritoneal Sclerosismentioning

confidence: 99%

Encapsulating peritoneal sclerosisâ€”a rare but devastating peritoneal disease

et al. 2015

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Encapsulating peritoneal sclerosis (EPS) is a devastating but, fortunately, rare complication of long-term peritoneal dialysis. The disease is associated with extensive thickening and fibrosis of the peritoneum resulting in the formation of a fibrous cocoon encapsulating the bowel leading to intestinal obstruction. The incidence of EPS ranges between 0.7 and 3.3% and increases with duration of peritoneal dialysis therapy. Dialysis fluid is hyperosmotic, hyperglycemic, and acidic causing chronic injury and inflammation in the peritoneum with loss of mesothelium and extensive tissue fibrosis. The pathogenesis of EPS, however, still remains uncertain, although a widely accepted hypothesis is the “two-hit theory,” where, the first hit is chronic peritoneal membrane injury from long standing peritoneal dialysis followed by a second hit such as an episode of peritonitis, genetic predisposition and/or acute cessation of peritoneal dialysis, leading to EPS. Recently, EPS has been reported in patients shortly after transplantation suggesting that this procedure may also act as a possible second insult. The process of epithelial–mesenchymal transition of mesothelial cells is proposed to play a central role in the development of peritoneal sclerosis, a common characteristic of patients on dialysis, however, its importance in EPS is less clear. There is no established treatment for EPS although evidence from small case studies suggests that corticosteroids and tamoxifen may be beneficial. Nutritional support is essential and surgical intervention (peritonectomy and enterolysis) is recommended in later stages to relieve bowel obstruction.

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“…17 Unlike the fibrosis of EPS, simple peritoneal fibrosis is confined to the parietal peritoneum and is an anticipated consequence of long-term exposure to PD therapy. [17][18][19] The sole finding of a thickened peritoneal membrane, therefore, does not imply that the patient has EPS.…”

Section: Discussionmentioning

confidence: 99%

Encapsulating peritoneal sclerosis: Importance to the hemodialysis practitioner

Perl

Bargman

Chan

2009

Hemodialysis International

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Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of long-term peritoneal dialysis (PD) therapy. Encapsulating peritoneal sclerosis is characterized by peritoneal membrane inflammation, followed by progressive peritoneal membrane fibrosis and intestinal encapsulation. Clinical manifestations include ascites as well as intermittent and recurrent small bowel obstruction. The prognosis of EPS is poor. The exact cause of EPS remains unknown. While the risk factors for EPS are not well elucidated, EPS is seen with increased frequency after an increased duration of PD therapy. In more than half the patients who develop EPS, the diagnosis is made after transfer to hemodialysis (HD). It is important for the HD practitioner to initiate surveillance in any patient at risk for EPS while maintaining a heightened index of suspicion for EPS in an HD patient with gastrointestinal symptoms and a history of previous PD therapy. Early diagnosis and prompt initiation of treatment is essential. Early in the course of EPS, immunosuppressive therapy remains the mainstay of treatment. Ultimately, parenteral nutritional support may be required along with surgical therapy to relieve intestinal obstruction. We report a case of EPS in an HD patient at our center highlighting the incidence, risk factors, and treatment strategies in the context of available evidence.

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Sclerosing Peritonitis: A Nosological Entity

Cited by 39 publications

References 7 publications

Peritoneal Dialysis: The Great Savior during Disasters

Peritoneal Dialysis: The Great Savior during Disasters

Encapsulating peritoneal sclerosisâ€”a rare but devastating peritoneal disease

Encapsulating peritoneal sclerosis: Importance to the hemodialysis practitioner

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