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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Article info
Publication history
Published online: December 10, 2022
Accepted:
December 5,
2022
Received in revised form:
November 20,
2022
Received:
September 29,
2022
Identification
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