Abstract
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.
Highlights
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
A longitudinal midline incision was made and the cocoon was carefully separated from the anterior abdominal wall (Fig. 2a)
Starting inferiorly, bowel loops were separated from the overlying inflammatory rind inch-by-inch
Summary
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. 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.
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