Sclerosing encapsulating peritonitis in chronic ambulatory peritoneal dialysis

Sclerosing encapsulating peritonitis is now a well-recognised, but uncommon, complication of chronic ambulatory peritoneal dialysis. Patients present with impaired ultrafiltration capacity, abdominal pain, nausea, vomiting and episodes of small bowel obstruction. Barium studies of the small bowel are characteristic, showing varying lengths of intestine tightly enclosed in a 'cocoon' of thickened peritoneum, proximal small bowel dilatation and an increased transit time. Ultrasonography may show a thick-walled mass containing bowel loops, loculated ascites and fibrous adhesions. With the increasing use of ambulatory peritoneal dialysis in the treatment of end-stage renal failure, it is important that this condition is recognised. The prognosis is poor when the bowel becomes obstructed; before this happens the offending 'sclerotic' membrane may be amenable to surgical removal.