Surgical Approach for Recurrent Encapsulating Peritoneal Sclerosis A Case Report

Michiaki Watanabe, Hideharu Mukai*, Yoshihiko Takao, Masaaki Nakayama**, Sadao Anazawa and Katsuhiko Yanaga

Department of Surgery, Jikei University School of Medicine
Department of Surgery, Furukawabashi Hospital*
Tohoku University Graduate School of Medicine, Research Division of Dialysis and Chronic Kidney Disease**

A 55-year-old male who had been treated by continuous ambulatory peritoneal dialysis (CAPD) for chronic renal failure for the past 8 years developed intestinal obstruction. The CAPD was discontinued, and hemodialysis was instituted. Encapsulating peritoneal sclerosis (EPS) was diagnosed in 2002 and treated surgically by total intestinal enterolysis. Small bowel obstruction recurred 9 months later, and recurrent EPS was diagnosed. Conservative treatment was effective at once, it was ineffective at second time and reoperation was indicated. Intraoperatively, a thick, firm membrane covered the entire intestine the same as observed during the first operation, and postoperative adhesions were also noted. All of the membranes were peeled off, and the adhesions were detached from the entire intestine. Peristalsis was confirmed after the enterolysis. An ileostomy was created for protection against ileal injury. The patient regained full oral intake. The surgical treatment for postoperative recurrence of EPS seems to be safe and effective.

Key words
encapsulating peritoneal sclerosis, continuous ambulatory peritoneal dialysis, sclerosing encapsulating peritonitis

Reprint requests
Michiaki Watanabe Department of Surgery, Jikei University, School of Medicine
3-25-8 Nishi-shinbashi, Minato-ku, 105-8461 JAPAN

Accepted
January 31, 2007

To read the PDF file you will need Abobe Reader installed on your computer.