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Encapsulating Peritoneal Sclerosis: The Abdominal Cocoon.

Manphool Singhal1, Satheesh Krishna1, Anupam Lal1

  • 1From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.).

Radiographics : a Review Publication of the Radiological Society of North America, Inc
|December 12, 2018
PubMed
Summary
This summary is machine-generated.

Encapsulating peritoneal sclerosis (EPS) is a rare condition causing bowel obstruction due to peritoneal membrane thickening. Diagnosis relies on imaging, with CT being the preferred modality for identifying characteristic findings.

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Area of Science:

  • Radiology
  • Gastroenterology
  • Pathology

Background:

  • Encapsulating peritoneal sclerosis (EPS) is a severe condition characterized by bowel encapsulation within a thickened peritoneal membrane, leading to recurrent bowel obstruction.
  • Etiology is multifactorial, with long-term peritoneal dialysis and bacterial peritonitis (especially tuberculosis) being significant predisposing factors.

Purpose of the Study:

  • To review the nomenclature, etiopathogenesis, and multimodality imaging features of encapsulating peritoneal sclerosis.
  • To differentiate EPS from mimicking conditions and provide an overview of management options.

Main Methods:

  • Review of literature on encapsulating peritoneal sclerosis.
  • Analysis of radiologic findings including radiographs, small-bowel follow-through, ultrasound (US), and computed tomography (CT).

Main Results:

  • Radiographs are often normal; small-bowel follow-through shows a "concertina-like" or "U-shaped" configuration.
  • US may reveal a "cauliflower" or "trilaminar" appearance. CT is the preferred modality, identifying a thickened, contrast-enhancing peritoneal membrane and clumped, encapsulated bowel loops.
  • CT can also help identify the cause (e.g., omental granuloma in tuberculosis) and complications (e.g., bowel obstruction).

Conclusions:

  • Encapsulating peritoneal sclerosis presents with nonspecific clinical features, necessitating knowledge of characteristic radiologic findings for diagnosis.
  • Multimodality imaging, particularly CT, is crucial for diagnosing EPS, identifying its cause, and detecting complications, guiding management strategies.