Encapsulating peritoneal sclerosis: a three-case series highlighting diagnostic challenges and surgical managements

Area of Science:

• Gastroenterology
• Abdominal Surgery
• Pathology

Background:

• Encapsulating peritoneal sclerosis (EPS) is a rare fibro-inflammatory disorder of the peritoneum.
• It causes a dense membrane that constricts the small bowel, mimicking other causes of intestinal obstruction.
• Timely diagnosis is challenging due to varied clinical presentations.

Purpose of the Study:

• To report three cases of idiopathic EPS.
• To highlight the diagnostic complexities and challenges in managing EPS.
• To emphasize the role of surgical intervention in diagnosis and treatment.

Main Methods:

• Case series of three patients with idiopathic EPS.
• Review of clinical presentations, radiologic findings (CT scans), and intraoperative findings.
• Surgical exploration (laparotomy) with adhesiolysis and decapsulation.

Main Results:

• Patients presented with bowel obstruction and radiologic findings suggestive of other conditions (herniation, adhesions, closed-loop obstruction).
• Intraoperative findings revealed dense adhesions and fibrous encapsulation, despite the absence of typical risk factors like peritoneal dialysis or tuberculosis.
• CT scans aided suspicion but lacked specificity for preoperative diagnosis.

Conclusions:

• Operative intervention is definitive for diagnosing and treating EPS-related bowel obstruction.
• EPS should be considered in unexplained small-bowel obstruction, even without conventional risk factors.
• Heightened clinical vigilance is necessary to prevent management delays.