Bleeding Peritoneum During Peritoneal Dialysis: A Case of Early Encapsulating Peritoneal Sclerosis?

Abstract

Complications of peritoneal dialysis (PD) create a significant burden for patients and providers. Some complications, such as infections and leaks, are preventable or easily treatable; however, potential fatal complications, such as encapsulating peritoneal sclerosis (EPS), cost patients their lives. Here, we present the case of a PD patient who might have had early, subtle, but ominous symptoms and signs of EPS, diagnosed in its early stages and promptly managed.A 57-year-old man who had been receiving PD for 6 years began having recurrent episodes of abdominal pain, blood-tinged effluent, and peritonitis. Even after successful treatment of his peritonitis episode, his dialysate effluent would be intermittently hazy or pinkish. When he presented with similar complaints for the third time, he was diagnosed with EPS after laparoscopy for further evaluation during his hospitalization.Encapsulating peritoneal sclerosis is a rare complication of PD. The advanced stages of EPS with "EPS syndrome" portend a grave prognosis because of small-bowel obstruction, malnutrition, infection, and death. Early recognition and timely intervention can be a strategy to potentially prevent the progression of EPS.