Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2022; 14(4): 352-361
Published online Apr 27, 2022. doi: 10.4240/wjgs.v14.i4.352
Surgical timing for primary encapsulating peritoneal sclerosis: A case report and review of literature
Peng Deng, Long-Xin Xiong, Ping He, Jian-Hua Hu, Qi-Xu Zou, Shi-Lian Le, Sen-Lin Wen
Peng Deng, Long-Xin Xiong, Ping He, Qi-Xu Zou, Shi-Lian Le, Sen-Lin Wen, Department of General Surgery, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
Jian-Hua Hu, Department of Emergency Surgery, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
Author contributions: Deng P, Xiong LX, and He P wrote the main manuscript text; Deng P, He P, and Wen SL reviewed the literature; Zhou QX prepared Figures 1-3; Hu JH prepared Table 1; all authors edited, read, and approved the final manuscript.
Supported by the Key Projects of Support Plan of Nanchang Science and Technology Bureau, Jiangxi Province, China, No. [2020]153.
Informed consent statement: Written informed consent was obtained from the patient and her husband for treatment and the publication of this case and any accompanying images.
Conflict-of-interest statement: The authors declare having no potential conflicts of interest.
CARE Checklist (2016) statement: The manuscript was revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Long-Xin Xiong, MD, Chief Doctor, Professor, Department of General Surgery, The First Hospital of Nanchang, No. 128 Xiangshan Road, Nanchang 330008, Jiangxi Province, China. xlx20211027@126.com
Received: November 28, 2021
Peer-review started: November 28, 2021
First decision: December 26, 2021
Revised: January 6, 2022
Accepted: March 26, 2022
Article in press: March 26, 2022
Published online: April 27, 2022
Processing time: 147 Days and 0.7 Hours
Abstract
BACKGROUND

Primary encapsulating peritoneal sclerosis (EPS) is a rare but devastating disease that causes fibrocollagenous cocoon-like encapsulation of the bowel, resulting in bowel obstruction. The pathogenesis, prevention, and treatment strategies of EPS remain unclear so far. Since most patients are diagnosed during exploratory laparotomy, for the non-surgically diagnosed patients with primary EPS, the surgical timing is also uncertain.

CASE SUMMARY

A 44-year-old female patient was referred to our center on September 6, 2021, with complaints of abdominal distention and bilious vomiting for 2 d. Physical examination revealed that the vital signs were stable, and the abdomen was slightly distended. Computerized tomography scan showed a conglomerate of multiple intestinal loops encapsulated in a thick sac-like membrane, which was surrounded by abdominal ascites. The patient was diagnosed with idiopathic EPS. Recovery was observed after abdominal paracentesis, and the patient was discharged on September 13 after the resumption of a normal diet. This case raised a question: When should an exploratory laparotomy be performed on patients who are non-surgically diagnosed with EPS. As a result, we conducted a review of the literature on the clinical manifestations, intraoperative findings, surgical methods, and therapeutic effects of EPS.

CONCLUSION

Recurrent intestinal obstructions and abdominal mass combined with the imaging of encapsulated bowel are helpful in diagnosing idiopathic EPS. Small intestinal resection should be avoided.

Keywords: Primary encapsulating peritoneal sclerosis; Abdominal cocoon; Intestinal obstruction; Case report

Core Tip: Primary encapsulating peritoneal sclerosis (EPS), also called an abdominal cocoon, is so rare that the etiology, pathogenesis, treatment strategies of primary EPS remain vague. We reported a case of primary EPS and carried out a comprehensive literature analysis. The data indicated for the first time that recurrent intestinal obstructions and abdominal mass combined with the imaging of encapsulated bowel are helpful in diagnosing primary EPS. Surgical treatments are promising, but care should be taken to avoid small intestinal resection. Elective abdominal exploration might decrease complications of patients with primary EPS, but further research is required to substantiate this.