Encapsulating Peritoneal Sclerosis Leading to Small Bowel Obstruction in a Young Woman with End-Stage Renal Disease: A Case Report.

Abstract

BACKGROUND Encapsulating peritoneal sclerosis (EPS) is a life-threatening complication of peritoneal dialysis (PD). It is characterized by a fibrous membrane partially or totally encasing the small bowel and is a rare cause of small bowel obstruction (SBO). Here we present a case of a young woman with a history of PD presenting with SBO due to EPS. CASE REPORT A 37-year-old woman with end-stage renal disease secondary to uncontrolled hypertension previously on PD presented to the emergency department for evaluation of 1 week of intractable nausea and vomiting associated with diffuse abdominal pain. Computed tomography of the abdomen showed findings consistent with a fibrous membrane encapsulating the small bowel and a small bowel follow-through revealed an SBO. She was diagnosed with secondary stage 3 EPS due to PD. She was started on prednisone and tamoxifen with quick resolution of her symptoms. Unfortunately, due to numerous recurrent SBOs, she is now being evaluated for surgical treatment options. CONCLUSIONS This report has presented a case of EPS, a rare complication of PD, which requires early diagnosis and management to prevent potentially fatal consequences. Management should focus on treating the underlying condition, optimizing nutrition, and using corticosteroids or tamoxifen (alone or in combination) depending on disease state and contraindications, with the aim of reducing recurrent SBOs. Failure of conservative management may require surgical evaluation.