Department of General Surgery, Honjoudaiichi Hospital, Akita, Iwabuchishita, Yurihonnjou, 110015-8567, Japan.
J Med Case Rep. 2021 Feb 6;15(1):35. doi: 10.1186/s13256-021-02679-8.
Encapsulating peritoneal sclerosis (EPS) is a rare condition in which the small intestine is covered by an inflammatory fibrocollagenous membrane; the exact etiology of EPS is unclear. Herein, we report the case of our patient who underwent hemodialysis and cell-free and concentrated ascites reinfusion therapy (CART) and was diagnosed with EPS.
A 64-year-old Japanese man visited our emergency department with a chief complaint of abdominal pain. He had a medical history of cirrhosis due to hepatitis C for 25 years. He had undergone partial resection of the small intestine 2 years earlier for an incarcerated hernia. One year earlier, he experienced renal failure due to hepatorenal syndrome and started hemodialysis three times a week and CART twice a month. Physical examination of the abdominal wall revealed a lack of peristalsis of the intestinal tract and strong tenderness on palpation. Because hernia of the small intestine was found on computed tomography, we suspected strangulation ileus, requiring emergency operation. When the abdomen was opened, the entire small intestine was found to be wrapped in a fibrous membrane and constricted by it. The patient was diagnosed with EPS; hence, during surgery, the fibrous membrane was excised, resulting in decompression of the intestinal tract and subsequent recovery.
EPS is thought to be related to various elements, but no case of EPS induced by CART has been reported to date. EPS should be considered in the differential diagnosis of small bowel obstruction in patients undergoing CART for refractory ascites.
包裹性腹膜硬化症（EPS）是一种罕见的疾病，其特征为小肠被一层炎症性纤维胶原膜所覆盖；EPS 的确切病因尚不清楚。在此，我们报告了一例接受血液透析和无细胞浓缩腹水再输注治疗（CART）并被诊断为 EPS 的患者。
一名 64 岁的日本男性因腹痛就诊于我院急诊科。他有 25 年丙型肝炎引起的肝硬化病史。2 年前因嵌顿疝行小肠部分切除术。1 年前因肝肾综合征导致肾衰竭，开始每周进行 3 次血液透析和每月 2 次 CART。腹壁体格检查显示肠道蠕动消失，触诊时有明显压痛。由于 CT 发现小肠疝，我们怀疑为绞窄性肠梗阻，需要紧急手术。打开腹部后，发现整个小肠都被一层纤维膜包裹并被其收缩。患者被诊断为 EPS；因此，在手术中切除了纤维膜，使肠道得到减压，随后恢复。
EPS 被认为与多种因素有关，但迄今为止尚未有报道称 CART 引起 EPS。在对接受难治性腹水 CART 治疗的患者进行小肠梗阻的鉴别诊断时，应考虑到 EPS。
