Surgical Treatment of Encapsulating Peritoneal Sclerosis in Patients with Continuous Ambulatory Peritoneal Dialysis -Efficacy of Decorticating All Sclerosing Peritoneum-

Reiichi Murakami, Ikuo Horigome, Yoshio Taguma, Takaomi Sato*, Noritoshi Amada*, Takashi Orii*, Hiroyuki Kikuchi*, Shigeru Sasaki* and Yoichi Ohashi**

Department of Nephrology, Sendai Shakaihoken Hospital
Department of Surgery, Sendai Shakaihoken Hospital*
Depertment of Surgery, Katta General Hospital**

Encapsulating peritoneal sclerosis (EPS) is a complication of continuous ambulatory peritoneal dialysis (CAPD). Adhesion of peritoneum undergoing fibrosis causes bowel dysfunction with associated abdominal pain, nausea, and vomiting. We report 5 EPS patients -4 men and 1 woman- aged 28 to 67 years. All were treated with total parenteral nutrition (TPN) and corticosteroid therapy, but 4 eventually required surgery, i.e.) adhesional lysis, with also requiring resection of a segment of the ileum difficult to remove. Although the immediate postoperative course was uneventful, 1 patient needed additional surgery to remove a parahepatic cyst encapsulated by residual sclerosing peritoneum 8 months after initial surgery. All 4 surgically treated now undergo hemodialysis and are free of abdominal symptoms. Surgical treatment of EPS should be conducted at an appropriate stage of disease, and if possible, adequate, meticulous decortication of all sclerosing peritoneum is recommended.

Key words
peritoneal dialysis, encapsulating peritoneal sclerosis, surgery

Reprint requests
Reiichi Murakami Second department of Internal Medicine, Hirosaki University School of Medicine
5 Zaifucho, Hirosaki, 036-8562 JAPAN

Accepted
November 30, 2004

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