Case report: abdominal cocoon syndrome following peritoneal dialysis presenting as closed-loop small bowel...

Encapsulating peritoneal sclerosis (EPS) is a rare but life-threatening complication of long-term peritoneal dialysis (PD) characterized by fibrocollagenous encapsulation of the bowel. We report a 37-year-old female with a 5-year history of PD who presented with acute abdominal pain, bilious vomiting, and abdominal distension secondary to a closed-loop small bowel obstruction. Computed tomography (CT) demonstrated characteristic findings, including bowel tethering, peritoneal thickening, and septated fluid collections suggestive of EPS. Emergency exploratory laparotomy confirmed extensive bowel encapsulation by a dense fibrotic membrane. The patient underwent enterolysis, adhesiolysis, excision of the fibrotic capsule, bowel resection, and primary anastomosis. The patient gradually recovered and was transitioned permanently to hemodialysis. This case emphasizes the diagnostic challenge of EPS and highlights the essential role of CT and timely surgical intervention in reducing the significant morbidity and mortality associated with this condition.