Post-transplantation encapsulating peritoneal sclerosis without inflammation or radiological abnormalities.
BACKGROUND
Post-transplantation encapsulating peritoneal sclerosis (EPS) causing bowel obstruction has been identified as a serious complication after kidney transplantation in patients previously treated with peritoneal dialysis. Systemic inflammation and abnormalities on an abdominal computed tomography (CT) scan are important hallmarks of EPS. To our knowledge, this is the first report of a case being diagnosed with late-onset post-transplantation EPS without systemic inflammation or abnormalities on a CT scan which could only be diagnosed by laparotomy.


METHODS
A 59-year old female presented because of symptoms of bowel obstruction 33 months after kidney transplantation. The patient had a 26-month history of peritoneal dialysis before her first kidney transplantation and was treated with peritoneal dialysis for 4 years before undergoing a second kidney transplantation. Physical examination was unremarkable and laboratory tests showed no signs of systemic inflammation (C-reactive protein <1 mg/L). An abdominal CT scan did not reveal any abnormalities fitting the diagnosis of EPS, except a "feces sign". Given the severity of the progressive symptoms, a diagnostic laparotomy was performed, visualizing a classical EPS. Total peritonectomy and enterolysis were performed, leading to restoration of peristalsis.


CONCLUSIONS
EPS may occur several years after kidney transplantation in the absence of inflammation and typical radiological abnormalities. Obtaining a diagnosis of post-transplantation EPS is challenging, however, a low threshold for surgical exploration in case of high clinical suspicion and negative findings on the CT scan is mandatory.
Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, D-414, P,O, Box 2040, Rotterdam 3000, CA, The Netherlands. m.g.h.betjes@erasmusmc.nl.
Sayed Meelad
SM
Habib
Frank Johan Marinus Frederik
FJ
Dor
Mario Richard
MR
Korte
Sander Martijn
SM
Hagen
Michiel Gerardus Henricus
MG
Betjes
D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D009393:Nephritis / Q000000981:diagnostic imaging / Q000209:etiology; D056627:Peritoneal Fibrosis / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D011859:Radiography; D016896:Treatment Outcome