Department of Internal Medicine, Brookwood Baptist Health, Birmingham, AL, USA.
Department of Internal Medicine, Our Lady of Fatima University, Valenzuela City, Philippines.
Am J Case Rep. 2024 Oct 28;25:e945398. doi: 10.12659/AJCR.945398.
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.
包裹性腹膜硬化症（EPS）是腹膜透析（PD）的一种危及生命的并发症。其特征为纤维膜部分或完全包裹小肠，是小肠梗阻（SBO）的罕见原因。在此，我们报告一例有 PD 病史的年轻女性，因 EPS 导致 SBO。
一名 37 岁女性，因不受控制的高血压导致终末期肾病，先前接受 PD 治疗，因 1 周难治性恶心和呕吐伴弥漫性腹痛到急诊科就诊。腹部 CT 显示符合小肠被纤维膜包裹的发现，小肠透视显示 SBO。她被诊断为继发性 3 期 PD 相关 EPS。她开始接受泼尼松和他莫昔芬治疗，症状迅速缓解。不幸的是，由于多次反复发作 SBO，她现在正在评估手术治疗方案。
本报告介绍了一例 EPS，这是 PD 的罕见并发症，需要早期诊断和管理以预防潜在的致命后果。治疗应侧重于治疗基础疾病、优化营养，并根据疾病状态和禁忌症使用皮质类固醇或他莫昔芬（单独或联合使用），以减少 SBO 的复发。保守治疗失败可能需要手术评估。
