Vnitr Lek 2007, 53(2):164-168

Encapsulating peritoneal sclerosis

L. Fantová^1,3,*, R. Šafářová^1,2, S. Vaňková^1,2

¹ Dialyzační středisko EuroCare, Praha 4, vedoucí prim. MUDr. Světlana Vaňková

² 3. lékařská fakulta UK, Praha

³ Nefrologická ambulance Centromed a.s., Praha, ředitelka MUDr. Milana Dokulilová

Encapsulating peritoneal sclerosis (EPS) is a rare complication of peritoneal dialysis (PD) characterized by extensive peritoneal fibrosis and bowel obstruction. Opinions on its etiopathogenesis diverge. It appears that the performance of peritoneal dialysis itself and the exposition of the peritoneum to non-physiological influences (the incidence increases in proportion to the length of peritoneal dialysis treatment) is an important factor. Yet there is also patients' individual sensitiveness, which apparently depends on individual immunological response. EPS causes severe changes in peritoneal anatomy and functions, resulting both in the loss of the transport function of the peritoneum, and in bowel malfunction and serious malnutrition. Imaging methods (ultrasound, computer tomography) are very important in diagnosing EPS; the diagnosis is confirmed histologically. No laboratory markers have been discovered yet to allow for timely indication of EPS development. There are different treatment strategies, including different surgical interventions (liberation of bowel loops, peritoneum resection) and the effort to influence the immune process. Corticosteroids remain the medication of choice; also promising is Tamoxifen. In spite of that, EPS mortality is still very high, ranging between 56 and 93 %. The disease often progresses even after peritoneal dialysis has finished. The article summarises the existing knowledge about encapsulating peritoneal sclerosis, its diagnosis and therapy.

Keywords: peritoneal dialysis; peritoneal sclerosis; peritoneal solution; peritonitis; bowel obstruction; immunosuppression

Received: August 18, 2006; Accepted: October 24, 2006; Published: February 1, 2007  Show citation