Entrapped in the Cocoon: A Rare Case of Sclerosing Encapsulating Peritonitis in a Patient on Dialysis

Sclerosing encapsulating peritonitis (SEP), also known as abdominal cocoon syndrome, is a rare and potentially fatal condition characterized by the encasement of the small intestine within a dense fibrotic membrane. Fewer than 250 cases have been reported worldwide. We present a case of SEP in a patient on chronic peritoneal dialysis (PD). A 66-year-old female with end-stage renal disease on chronic PD presented with worsening abdominal pain, distension, and hypotension. Laboratory evaluation revealed leukocytosis and an elevated peritoneal fluid white blood cell count. Peritoneal fluid cultures grew Candida glabrata, and treatment with intravenous antifungal and broad-spectrum antibiotics was initiated. Despite appropriate therapy and PD catheter removal, her symptoms persisted. Computed tomography (CT) of the abdomen and pelvis demonstrated loculated ascites and bowel loops encased in a fibrotic membrane, consistent with SEP. She was subsequently transferred to a tertiary care center for surgical decortication. SEP is a rare but serious complication in patients on PD, often presenting as refractory peritonitis. Early diagnosis through clinical suspicion and imaging is crucial, as timely surgical intervention remains the definitive treatment to prevent bowel obstruction and improve outcomes.