Encapsulating Peritoneal Sclerosis: Pathophysiology, Diagnosis, and Management of a Rare but Devastating Complication of Peritoneal Dialysis
Introduction Encapsulating peritoneal sclerosis (EPS) is a rare but life-threatening complication primarily associated with long-term peritoneal dialysis (PD) in patients with end-stage kidney disease (ESKD). Although uncommon, EPS carries a high morbidity and mortality, often due to progressive intestinal obstruction and malnutrition. Characterized by extensive fibrosis and calcification of the peritoneum, EPS forms a dense “cocoon” encasing the bowel loops, leading to encapsulation, tethering, and eventual obstruction. This article explores the pathophysiology, epidemiology, clinical features, imaging findings, differential diagnosis, treatment strategies, and prognosis of EPS, illustrated with imaging examples, and concludes with questions for learners. Pathophysiology EPS arises from chronic peritoneal inflammation and fibrosis. The process is believed to be “two-hit”: First Hit – Chronic peritoneal insult Long-term exposure to bio-incompatible PD fluids, rich in glucos...