Encapsulating peritoneal sclerosis in hemodialysis patient: a case report

Abstract

Background: Encapsulating peritoneal sclerosis is a rare manifestation nowadays. Case Report: This was a case report of a young female with ESKD on hemodialysis for more than 6 months with a previous history of continuous ambulatory peritoneal dialysis (CAPD) and recurrent peritonitis which currently presented with painful abdominal distension. The CT scan of the abdomen showed a clumping of small bowel loops at the left side encased into a thin fibrocartilaginous membrane. Initially, she was treated for intrabdominal sepsis; however, after recurrent admission, intravenous Methylprednisolone was started, followed by high-dose steroids and tamoxifen as a treatment for encapsulating peritoneal sclerosis (EPS). Surprisingly, she improved and had a good clinical response. She was readmitted again after a few months with abdominal pain due to an abrupt stop in steroid but improved again after the steroid was started. Conclusion: Abdominal pain in a patient with a history of CAPD peritonitis needs to raise suspicion of EPS even though is rare. Radiological Imaging is helpful in making early diagnosis. The most important thing is steroids as a mainstay of the treatment of EPS besides tamoxifen with a minimal 1-year duration or lifelong as surgical intervention is very risky.