The Open Urology & Nephrology Journal

ISSN: 1874-303X ― Volume 13, 2020

Encapsulating Peritoneal Sclerosis

Derek Larson*, 1, Siddiq Anwar2, Tushar J. Vachharajani3, Daniel Hafenrichter4
1 Department of Nephrology, Missouri Baptist Medical Center, St Louis, MO, USA
2 Department of Sunde rland Royal Hospital, Sunderland, UK
3 Department of W.G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, NC, USA
4 Department of Midwest Vascular and General Surgery, St. Louis, MO, USA


Encapsulating Peritoneal Sclerosis (EPS) developed in an African American male who had been on Peritoneal Dialysis for nine years. During his hospitalization for peritonitis, he continued to clinically deteriorate with refractory abdominal pain, vomiting, and anorexia requiring Total Parenteral Nutrition. This case demonstrates the importance of prompt EPS diagnosis and the technical challenges associated with surgical treatment.

Keywords: Encapsulating peritonitis, peritoneal dialysis, peritoneal sclerosis, peritonitis.

Article Information

Identifiers and Pagination:

Year: 2016
Volume: 9
First Page: 1
Last Page: 3
Publisher Id: TOUNJ-9-1
DOI: 10.2174/1874303X01609010001

Article History:

Received Date: 10/8/2014
Revision Received Date: 10/8/2014
Acceptance Date: 10/3/2015
Electronic publication date: 28/1/2016
Collection year: 2016

© Larson et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the St. Louis Kidney Consultants, 12855 N. Forty Drive, Suite 205 - North Tower, St. Louis, MO 63141, USA; Tel: (314) 720-0900; Fax: (314) 548-6555; E-mail:


A 47-year-old African American male with end stage renal disease secondary to Thrombotic Thrombocytopenic Purpura, on peritoneal dialysis (PD) since 2006 presented in 2015 with abdominal pain and cloudy PD effluent bags due to PD peritonitis (PDP). He was a High-Average transporter and in 2007 had one episode of coagulase-negative staphylococcus PDP which resolved with antibiotics. During this admission, in view of his poor response to antibiotics and worsening clinical symptomatology, his PD catheter was removed. A computerized tomography scan (Fig. 1) raised suspicion of encapsulating peritoneal sclerosis, and in view of persistent symptoms of bowel obstruction, he was put forward for peritonectomy and enterolysis.

A longitudinal midline incision was made and the cocoon was carefully separated from the anterior abdominal wall (Fig. 2a). The peritoneum had a dense peritoneal rind that was evident. Next, starting inferiorly, bowel loops were separated from the overlying inflammatory rind inch-by-inch. No enterotomies were made during the procedure. The bowel had a very unusual appearance, which appeared to be ruddy and leathery with grooves and a golden luminescent-type appearance under the light. The dense capsule was carefully taken down and bowel was freed up from the ileocecal valve to the ligament of Treitz (Fig. 2b). The dense adhesions to the liver were carefully separated. The abdominal fascia was closed and the patient tolerated the procedure well.

Even with the advances in surgical techniques for advanced EPS, the post-operative mortality ranges between 19-35% [1Kawanishi H. Surgical and medical treatments of encapsulation peritoneal sclerosis. Contrib Nephrol 2012; 177: 38-47.
[] [PMID: 22613913]
]. especially in those who present as surgical emergencies. The recurrence rates post-surgery have been reported as high as 25% [2Moinuddin Z, Summers A, Van Dellen D, Augustine T, Herrick SE. Encapsulating peritoneal sclerosis-a rare but devastating peritoneal disease. Front Physiol 2014; 5: 470.
[PMID: 25601836]
, 3Habib SM, Betjes MG, Fieren MW, et al. Management of encapsulating peritoneal sclerosis: a guideline on optimal and uniform treatment. Neth J Med 2011; 69(11): 500-7.
[PMID: 22173363]
]. Despite the good outcome in our patient, PD patients, especially with high transporter status who choose to remain on peritoneal dialysis for more than 5 years, need to be counselled on this devastating complication of peritoneal dialysis.

Fig. (1)

There is moderate to large amount of ascites and a membrane coating the bowel measuring roughly 2 to 3 mm in thickness with some enhancement. There is also some evidence of membrane formation along the parietal surface of the peritoneum. There is no evidence of plaque-like calcification.

Fig. (2)

(a) The coccon encasing the bowel loops after it was carefully separated from the anterior abdominal wall. (b) The bowel loops can be seen here after the capsule was carefully taken down and the dense interloop adhesions were lysed.


The authors confirm that this article content has no conflict of interest.


Declared none.


[1] Kawanishi H. Surgical and medical treatments of encapsulation peritoneal sclerosis. Contrib Nephrol 2012; 177: 38-47.
[] [PMID: 22613913]
[2] Moinuddin Z, Summers A, Van Dellen D, Augustine T, Herrick SE. Encapsulating peritoneal sclerosis-a rare but devastating peritoneal disease. Front Physiol 2014; 5: 470.
[PMID: 25601836]
[3] Habib SM, Betjes MG, Fieren MW, et al. Management of encapsulating peritoneal sclerosis: a guideline on optimal and uniform treatment. Neth J Med 2011; 69(11): 500-7.
[PMID: 22173363]
Society Affiliation

Track Your Manuscript:


"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."

Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."

Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."

Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."

Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."

Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."

Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."

Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."

J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."

Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."

Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."

Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."

Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."

Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."

M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."

Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."

Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."

Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."

Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."

Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."

Jih Ru Hwu
(National Central University, Taiwan)

Browse Contents

Table of Contents

Webmaster Contact:
Copyright © 2020 Bentham Open