A case of encapsulating peritoneal sclerosis suspected to result from the use of icodextrin peritoneal solution

Encapsulating peritoneal sclerosis (EPS) is an intestinal obstruction syndrome in which peritoneal deterioration and intraperitoneal inflammation result in intestinal adhesions, which are covered with a fibrin capsule and which cause bowel obstruction. Here, we report the case of a patient with EPS suspected to result from the use of icodextrin peritoneal solution. In this patient, peritoneal permeability to high molecular weight solutes and effluent interleukin-6 (IL-6) levels increased after initiation on-to icodextrin solution. The patient developed symptoms of intestinal obstruction accompanied by intestinal edema 30 months after the start of icodextrin and after a peritoneal dialysis (PD) duration of 78 months. He was then diagnosed as being in a pre-EPS state. The use of icodextrin solution was discontinued, and the symptoms of intestinal obstruction improved after corticosteroid administration. Subsequently, he was managed on a combination of PD using glucose solution low in glucose degradation products and of twice-weekly hemodialysis, but he showed enhanced peritoneal permeability and increases in effluent IL-6. After a PD period of 98 months, severe symptoms of intestinal obstruction developed, and enterolysis was performed. The degeneration of the intestinal wall itself was slight, and the adhesions between the capsule and intestinal surface could be readily removed. In this patient, the degree of peritoneal deterioration and capsule formation differed from that of typical EPS. These findings suggest the promotion of capsule formation by icodextrin solution and the involvement of certain inflammatory reactions.