Encapsulating peritoneal sclerosis

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Encapsulating peritoneal sclerosis (EPS) also known as sclerosing encapsulating peritonitis, is a rare but serious complication of long-term peritoneal dialysis in which progressive fibrotic thickening of the peritoneum can partially or completely encase the bowel, leading to recurrent or persistent bowel obstruction and malnutrition. Terminology for this condition varies by specialty and etiology. Not to be confused with congenital peritoneal encapsulation, a rare developmental anomaly in which a thin accessory peritoneal membrane encloses all or part of the small bowel.. In nephrology, encapsulating peritoneal sclerosis is commonly used for the form associated with long-term peritoneal dialysis. In surgical and radiology literature, abdominal cocoon is often used for idiopathic cases of sclerosing encapsulating peritonitis, although terminology is inconsistent across publications. Patients usually present with abdominal symptoms such as altered bowel habits, nausea, vomiting, anorexia, and early satiety. In the early stages, these symptoms can be linked to signs of inflammation such as pyrexia and elevated CRP, and/or blood-stained ascites. Abdominal pain, fullness, overt bowel obstruction, and the presence of an abdominal mass are linked to the late stages of encapsulating peritoneal sclerosis. The intestines become gradually covered with a fibrous cocoon, which causes weight loss, malnutrition, bowel obstruction, ischemia and strangulation, infection, and death. Encapsulating peritoneal sclerosis is typically observed in patients with end-stage renal disease (ESRD) receiving long-term peritoneal dialysis therapy.