title: Encapsulating peritoneal sclerosis - a 5 year experience.
abstract: BACKGROUND
  Encapsulating peritoneal sclerosis - A 5 year experience.
  
  
  OBJECTIVE
  Encapsulating peritoneal sclerosis (EPS) is a rare, life-threatening condition, characterised by a progressive, intra-abdominal inflammatory process resulting in fibrotic visceral constriction. We report the aetiology, management, and outcome of EPS in Belfast.
  
  
  METHODS
  All patients diagnosed with EPS in Belfast over the past 5 years are included. Presentation, aetiology, imaging, pathology, and outcome are retrospectively analysed and reported.
  
  
  RESULTS
  7 patients (4 males) were identified with EPS with a mean age 54 years (range 33-69). Aetiology included peritoneal dialysis (3), radiation enteritis (1), peritoneal dialysis and radiation enteritis (1), tuberculosis, cirrhosis, and beta-blocker use (1), infected aorto-bifemoral graft (1). Of the 7 patients, 5 underwent definitive surgery. Bowel conserving surgery (laparotomy, division of adhesions, excision of membrane) was performed in 4 patients. One patient required an ileocaecal resection for radiation enteritis. Median pre-operative and post-operative hospital stay were 25 and 62 days respectively. Three patients required total parenteral nutrition (TPN) pre-operatively, 3 patients post-operatively; with 4 of the 7 patients discharged on TPN. 5 out of 7 patients are alive at median follow-up of 24 months. There was no 30-day in-hospital mortality.
  
  
  CONCLUSIONS
  Patients with EPS often require parenteral nutrition before and after surgery. Peritoneal dialysis is a major risk factor for the development of EPS but other aetiologies should be considered. These patients have multiple co-morbidities, and operations for EPS are challenging with a high risk of peri-operative complications. Therefore these patients are best managed in a specialised unit with experience in intestinal failure surgery and access to a multi-disciplinary nutrition support team.
authors.affiliation: Department of Colorectal Surgery, Royal Victoria Hospital, Belfast. robert.spence@gmail.com
authors.forename: Robert
authors.initials: R
authors.lastname: Spence
authors.forename: Scott
authors.initials: S
authors.lastname: Gillespie
authors.forename: Maurice
authors.initials: M
authors.lastname: Loughrey
authors.forename: Keith
authors.initials: K
authors.lastname: Gardiner
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D056627:Peritoneal Fibrosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D010537:Peritoneum / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Peritoneal Fibrosis