Abstract
Encapsulating peritoneal sclerosis (EPS) is a serious complication of continuous ambulatory peritoneal dialysis (CAPD) and is characterized by progressive fibrosis and sclerosis of the peritoneum. We examined the histology of three different sites of the peritoneum in one CAPD case and that of two different sites of peritoneum in two CAPD cases. The duration of CAPD was 9 years in first case, 1 year in second case and 3 years in third case.
In the first case, patho-histological examination of the abdominal part of parietal peritoneum showed fibrous thickening and hyalinization of the peritoneum without mesothelial cells, but there was no sign of hypertrophy or obstruction of small artery, indicating the early stage of peritoneal sclerosis. While, histological findings of the mesenterium indicated mild fibrous thickening of the peritoneum with mesothelial cells, indicating moderate peritoneal fibrosis. Finally, histological findings of dorsal part of parietal peritoneum demonstrated severe fibrous thickening and hyalinization of the peritoneum without mesothelial cells accompanied with hypertrophy and obstruction of small artery, indicating an intermediate stage of peritoneal sclerosis. These findings show that function of the dorsal part of parietal peritoneum was the worst.
In the second and third cases, patho-histological diagnose showed mild peritoneal fibrosis, and there were no differences between the abdominal part and dorsal part of the parietal peritoneum.
Although the biopsy of the abdominal part of the parietal peritoneum is usually chosen for diagnosis of EPS, it is possible that disease in the dorsal part of the parietal peritoneum would show the most severe pathohistological findings in long-term CAPD cases. Therefore, multiple biopsies may be useful to determine whether CAPD should be discontinued to prevent the progression of EPS.
