Diagnosis and management of encapsulating peritoneal sclerosis.

Encapsulating peritoneal sclerosis is a rare but clinically important complication of peritoneal dialysis. In patients on long-term peritoneal dialysis, the high prevalence of the complication warrants a high index of suspicion and a low threshold for investigation--particularly in patients with ultrafiltration loss. Laparoscopic inspection of the peritoneum and peritoneal biopsy are required for definitive diagnosis. However, initial radiologic investigations may be useful. Although treatment options are based on a small number of anecdotal reports, once the diagnosis is confirmed and infection is excluded, it is reasonable for the peritoneal catheter to be removed and immunosuppressive therapy (with or without colchicine) to be commenced. Depending on the degree of bowel dysfunction at diagnosis, total parenteral nutrition may be commenced. In the absence of improvement, surgical intervention with total intestinal enterolysis may be attempted, recognizing the high morbidity and mortality associated with operative procedures in these patients. The ultimate aim is to prevent the development of encapsulating peritoneal sclerosis. Although a link is not proven, the development of more biocompatible dialysis fluids with less potential to result in glycosylation of the peritoneal membrane proteins will, it is hoped, reduce the occurrence of this devastating complication of peritoneal dialysis.