Idiopathic encapsulating peritoneal sclerosis: A case report

Encapsulating peritoneal sclerosis is a rare disease, characterized by subocclusive symptoms. Idiopathic forms could be challenging, as they are often mistaken for other conditions. We present a case mistaken for an internal hernia.

A 52-year-old male patient, who was complaining of abdominal pain and bloating for 6 months. He presented due to worsening of his symptoms. A CT scan was then performed evoking an internal hernia. Emergency surgery via laparoscopy revealed encapsulating peritoneal sclerosis with a cocoon-like fibrous tissue encasing the bowel. A conversion by a midline incision was performed for enterolysis and fibrous tissue resection.

Encapsulating peritoneal sclerosis (EPS), is a rare disease. Because of the rigid capsule surrounding the loops, symptomatology includes recurrent occlusive symptoms. The incidence of this pathology is unknown. EPS is often associated with peritoneal dialysis(PD), infections, and systemic inflammatory disorders. Idiopathic cases, like in our patient, are often misdiagnosed pre-operatively. The treatment focuses on the management of the underlying cause if identified. Corticoids are proposed in inflammatory diseases while switching to hemodialysis or the use of tamoxifen and immunosuppressive therapies are proposed in case of PD. In case of failure of the conservative approaches or in case of emergency, a peritonectomy and enterolysis could be performed despite being at high risk of recurrence and mortality.

We aimed to describe a case misdiagnosed as an internal hernia to raise awareness among practitioners about this condition.