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

Encapsulating peritoneal sclerosis (EPS) is a rare and heterogeneous fibro-inflammatory disorder of the peritoneum characterized by progressive formation of a dense fibrocollagenous membrane that envelopes and constricts the small bowel. Its protean clinical manifestations frequently overlap with other causes of intestinal obstruction, making timely diagnosis a persistent clinical challenge.

We report three cases of idiopathic EPS presenting with varying degrees of bowel obstruction and radiologic features initially suggestive of internal herniation, adhesive small-bowel obstruction, and intermittent closed-loop obstruction. All patients demonstrated dense adhesions or fibrous encapsulation intraoperatively, despite the absence of traditional risk factors such as peritoneal dialysis (PD) or abdominal tuberculosis (TB). CT findings aided early suspicion but lacked sufficient specificity to establish a preoperative diagnosis, underscoring the indispensable role of surgical exploration. Each patient underwent laparotomy with adhesiolysis and decapsulation, tailored to the extent of disease, with favorable postoperative outcomes.

These cases illustrate the diagnostic complexity of EPS and reinforce that operative intervention remains the definitive means of both confirming the diagnosis and restoring bowel function once fixed obstruction or encapsulation has developed. Our series emphasizes the importance of maintaining EPS in the differential diagnosis of unexplained small-bowel obstruction, even in the absence of conventional predisposing conditions, and highlights the need for heightened clinical vigilance to prevent delays in management.