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Abstract: FR-PO460

Entangled: An Unusual Case of Encapsulating Peritoneal Sclerosis

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis


  • Uribe, Ricardo, Audie L Murphy VA, San Antonio, Texas, United States
  • Duch, John M., Audie L Murphy VA, San Antonio, Texas, United States
  • Takkar, Chandan, Audie L Murphy VA, San Antonio, Texas, United States

Encapsulating Peritoneal Sclerosis (EPS) is one of the most serious complications of peritoneal dialysis (PD), characterized by progressive peritoneal membrane fibrosis and adhesions, and associated with high morbidity and mortality. Patients present with episodes of bowel obstruction, abdominal pain and distention, and weight loss. Risk factors include longer duration on PD, recurrent episodes of peritonitis and a high transporter status. We report a case of EPS on a patient presenting with new onset ascites and small bowel obstruction after transition from PD to Hemodialysis (HD).

Case Description

A 71 male with ESRD secondary to Diabetic Nephropathy, treated with HD for the past 6 months, presented with new onset ascites, abdominal pain and symptoms of small bowel obstruction (SBO). He had received PD for approximately 2.5 years, and was transitioned to HD due to 3 episodes of peritonitis. His transporter status prior to transition was high average. Ascitic fluid work up revealed serosanguinous fluid with a WBC count of 273/mm3 with 67% lymphocytes, Protein concentration of 4g/dL, Albumin concentration 2g/dL and SAAG of >1.1, negative cultures and cytology. Evaluation for cardiac and hepatic causes of ascites was unremarkable. CT showed bowel loop dilatation affecting duodenum and proximal jejunum. Patient was discharged after paracentesis and bowel rest. This was followed by six additional hospitalizations with similar presentation, over the course of one year, managed with bowel rest regimen for partial SBO. Abdominal imaging one year after index hospitalization revealed loculated ascites, small bowel clustering with surrounding peritoneal thickening and scattered calcifications. A diagnosis of EPS was made, and he was started on Tamoxifen and Prednisone.


This is an unusual case of EPS, presenting after a PD vintage of less than 3 years, albeit with the risk factors of recurrent peritonitis and high average transporter status. While the incidence of EPS in patients on PD < 3 years has been reported close to 0, there may be significant detection bias, related to the non-specific presenting symptoms and lack of characteristic imaging findings earlier on. Nephrologists should maintain a high index of suspicion in patients who have been on PD and present with non-specific GI symptoms, since intervention in the early, inflammatory phase, could perhaps lead to improved outcomes.