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Imaging pearls and differential diagnosis of encapsulating peritoneal sclerosis: Emphasis on computed tomography

  • Sitthipong Srisajjakul
    Correspondence
    Corresponding author at: Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
    Affiliations
    Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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  • Author Footnotes
    1 Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
    Patcharin Prapaisilp
    Footnotes
    1 Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
    Affiliations
    Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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  • Author Footnotes
    2 Department of Internal Medicine, Pratumtani Hospital, 7 Pratumtani-Ladlumkaew Road, Muang District, Pratumtani 12000, Thailand.
    Sirikan Bangchokdee
    Footnotes
    2 Department of Internal Medicine, Pratumtani Hospital, 7 Pratumtani-Ladlumkaew Road, Muang District, Pratumtani 12000, Thailand.
    Affiliations
    Department of Internal Medicine, Pratumthani Hospital, Thailand
    Search for articles by this author
  • Author Footnotes
    1 Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
    2 Department of Internal Medicine, Pratumtani Hospital, 7 Pratumtani-Ladlumkaew Road, Muang District, Pratumtani 12000, Thailand.
Published:December 10, 2022DOI:https://doi.org/10.1016/j.clinimag.2022.12.001

      Highlights

      • Causes of EPS can be classified as primary and secondary. The most common secondary cause is long term peritoneal dialysis.
      • The imaging of EPS can be divided into peritoneal abnormalities, small bowel abnormalities and loculated fluid collections.
      • The small bowel loops are conglomerated in a concertina-like appearance with kinking and tethering of fixed bowel loops.
      • The thickened peritoneum can progress to encapsulate small bowel resulting in small bowel obstruction.
      • Radiologic mimics of EPS include calcified peritoneal carcinomatosis, peritoneal tuberculosis, peritoneal mesothelioma.

      Abstract

      Encapsulating peritoneal sclerosis (EPS) is a severe peritoneal fibrotic reaction most frequently identified as a complication of peritoneal dialysis. EPS is a complex condition whose management requires multidisciplinary input from radiologists, gastroenterologists, nephrologists, surgeons, and dietitians. EPS carries significant morbidity and mortality, primarily due to bowel obstruction that results in intestinal failure, malnutrition, and sepsis. The nondialysis causes of EPS include tuberculous peritonitis, prior abdominal surgery, beta-blocker medication use, and endometriosis.
      The clinical symptoms of EPS are nausea, vomiting, and abdominal pain, all of which appear to be associated with bowel obstruction. The diagnosis of EPS needs three pillars to be met: clinical features, radiological evaluation, and histopathological analysis. The disease is frequently progressive and can be fatal.
      Computed tomography is the gold standard imaging modality for the detection of peritoneal abnormalities and encapsulation of bowel loops by thick adhesions or fibrosis (cocooning). Computed tomography also aids in making a differential diagnosis. Unfortunately, the diagnosis of EPS is often delayed because clinical findings are not specific and may resemble other peritoneal diseases. Radiologists should be familiar with the clinical impacts and related imaging features of EPS and realize when to seek them to facilitate timely and proper treatment.

      Keywords

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