O10
PERITONECTOMY IS A SUCCESSFUL TREATMENT FOR PATIENTS
WITH ENCAPSULATING PERITONEAL SCLEROSIS (EPS) FOLLOWING
RENAL TRANSPLANTATION
Summers, A M, de Freitas D, Hurst, H, Taylor, P, Hutchison, A J, Dunn, L, Brenchley,
P E C, Augustine, T
Manchester Royal Infirmary
Encapsulating peritoneal sclerosis (EPS) is an increasingly recognised complication
of long term peritoneal dialysis (PD), associated with deposition of fibrous sheets
which constrict and restrict the bowel. Surgical intervention has in several cases been
associated in the past with high mortality. EPS following renal transplantation is a
new phenomenon, occurring relatively soon post transplant despite
immunosuppression. Peritonectomy has been used to treat PD patients with EPS. We
report the first experience of peritonectomy in the management of EPS in the
transplant population.
We collected outcome data on renal allograft recipients who developed EPS following
transplantation in a single centre during the period of 3yrs from 2004 to 2006.
Diagnosis was based on both clinical and radiological findings, with surgical
confirmation. Patients with a clinical picture which included ascites, deteriorating
nutritional status, raised inflammatory markers and bowel obstruction underwent
adhesiolysis and complete peritonectomy.
11 patients developed EPS following renal transplantation in this period. Clinical
findings included ascites and symptoms of bowel obstruction. CT findings included
ascites, peritoneal thickening and calcification, abdominal cocoon, bowel thickening
and dilatation. 10 patients underwent surgery while one patient was treated
conservatively and has achieved a normal nutritional state. 9 patients underwent
peritonectomy and adhesiolysis, of whom 7 are now eating a normal diet. 5 of these
patients have residual symptoms including nausea, abdominal pain and constipation.
One patient underwent a repeat peritonectomy and is now almost symptom free. In
this group of patients there has been one death.
This is the first report of peritonectomy in the management of EPS following renal
transplantation with achievement of normal diet in the majority of patients. Unlike
previous reports with high surgical mortality up to 33%, there has only been a 10%
mortality in this group. This is a condition which should be considered in patients
with post transplant chronic abdominal symptoms and ascites. The key to successful
surgery is early semi-elective peritonectomy after adequate preparation.