Encapsulating Peritoneal Sclerosis: A Patient Guide

Disclaimer: This guide provides educational information about Encapsulating Peritoneal Sclerosis. If you experience new or persistent vomiting, severe or worsening abdominal pain, marked stomach distension, or the absolute inability to pass gas or stool, contact your medical team or emergency services immediately.

Encapsulating Peritoneal Sclerosis (EPS) is a rare and serious condition that affects the peritoneum, the thin membrane that lines your abdomen and covers your organs. In people with EPS, this membrane undergoes a severe fibro-inflammatory transformation, becoming a thick, scarred “cocoon” that eventually wraps around the intestines. As this layer tightens, it physically restricts the normal movement of the bowels, which can lead to recurrent obstructions, pain, swelling, and an inability to tolerate food ^[1][2].

While the condition is most strongly associated with people who have used peritoneal dialysis (PD) for many years, it often behaves unpredictably. For many patients, the symptoms only become clinically apparent after they have stopped peritoneal dialysis or after receiving a kidney transplant. The diagnosis is generally reached by looking at the clinical picture—combining the physical symptoms of bowel obstruction with specialized imaging, such as a CT scan, to identify the characteristic thickening, calcification, and “cocooning” of the intestines ^[3][4].

Managing EPS requires a highly coordinated, “all-hands-on-deck” approach to care. Because the condition directly impairs your ability to eat and pass food, intensive nutritional support—sometimes delivered directly into the bloodstream (TPN)—is a cornerstone of treatment. At the same time, doctors carefully transition patients off peritoneal dialysis (if they are still on it) and may use medications off-label to help calm inflammation. In some severe or persistent cases, a highly complex surgery called enterolysis and peritonectomy is needed to meticulously peel away the membrane and free the intestines, a procedure that requires a surgeon with deep experience in this specific disease ^[5][6].

Because EPS is so uncommon, it is essential to be cared for by a specialized multidisciplinary team that understands its complexities. This team typically includes nephrologists, gastrointestinal surgeons, dietitians, and specialists who can support your mental and emotional well-being. While the road ahead can be challenging and unpredictable, the focus of modern care is on stabilizing the condition, restoring your nutrition, and helping you return to the highest possible quality of life ^[7][8].