A Rare Presentation of Encapsulating Peritoneal Sclerosis

Introduction/Purpose: Encapsulating peritoneal sclerosis is a grave complication, which entails the intra abdominal contents being encased by a fibrinous capsule. This is usually a complication of peritoneal dialysis that develops over an extended period of time. There have been few cases reported of patients with no history of peritoneal dialysis.

Methods or Case Description: A 53 year old female presented to the ED after recent discharge from the same institution for spontaneous bacterial peritonitis. She had complaints of continued nausea, vomiting and abdominal pain since discharge. On exam she had a large fluid wave and was diffusely tender to palpation. CT findings were consistent with pneumoperitoneum. The patient was taken to the OR for an exploratory laparotomy and was found to have encapsulating peritoneal sclerosis. The fibrinous capsule encasing the intra abdominal contents was entered and an extensive lysis of adhesions was performed on the small bowel. The patient expired post operatively.

Outcomes: Encapsulating peritoneal sclerosis is a grave disease. This is a clinical diagnosis associated with recurrent bowel obstructions. This has classically been associated with long term peritoneal dialysis. The exact causes of peritoneal leading to EPS are unknown. Many patients present with non specific GI complaints and in later stages of the disease, obstruction and perforation is common. Imaging can be non specific to the disease process and the gold standard of diagnosis is laparatomy, which is both diagnostic and therapeutic.

Conclusion: Early diagnosis and treatment in patients found to have encapsulating peritoneal sclerosis is key. Optimization before surgery helps decrease morbidity and mortality rates, as usually these patients are not ideal surgical candidates. This was a complicated presentation with concern for bowel perforation, in which this was not possible.