Neirouz Kammoun, Haifa Ben Romdhane, Mehdi Trabelsi Mohamed, Faicel Ben Salah, Mohamed Ben Hassine, Hichem Jerraya
B Surgery Department, Charles Nicolle Hospital, Tunis, Tunisia.
Gastroenterology Unit, Mediterranean Clinic, Tunis, Tunisia.
Int J Surg Case Rep. 2025 Jan;126:110694. doi: 10.1016/j.ijscr.2024.110694. Epub 2024 Nov 30.
Encapsulating peritoneal sclerosis is a rare disease, characterized by subocclusive symptoms. Idiopathic forms could be challenging, as they are often mistaken for other conditions. We present a case mistaken for an internal hernia.
A 52-year-old male patient, who was complaining of abdominal pain and bloating for 6 months. He presented due to worsening of his symptoms. A CT scan was then performed evoking an internal hernia. Emergency surgery via laparoscopy revealed encapsulating peritoneal sclerosis with a cocoon-like fibrous tissue encasing the bowel. A conversion by a midline incision was performed for enterolysis and fibrous tissue resection.
Encapsulating peritoneal sclerosis (EPS), is a rare disease. Because of the rigid capsule surrounding the loops, symptomatology includes recurrent occlusive symptoms. The incidence of this pathology is unknown. EPS is often associated with peritoneal dialysis(PD), infections, and systemic inflammatory disorders. Idiopathic cases, like in our patient, are often misdiagnosed pre-operatively. The treatment focuses on the management of the underlying cause if identified. Corticoids are proposed in inflammatory diseases while switching to hemodialysis or the use of tamoxifen and immunosuppressive therapies are proposed in case of PD. In case of failure of the conservative approaches or in case of emergency, a peritonectomy and enterolysis could be performed despite being at high risk of recurrence and mortality.
We aimed to describe a case misdiagnosed as an internal hernia to raise awareness among practitioners about this condition.
包裹性腹膜硬化症是一种罕见疾病，以亚闭塞症状为特征。特发性形式可能具有挑战性，因为它们常常被误诊为其他病症。我们报告一例被误诊为内疝的病例。
一名52岁男性患者，主诉腹痛和腹胀6个月。因症状加重前来就诊。随后进行了CT扫描，提示内疝。通过腹腔镜进行急诊手术，发现包裹性腹膜硬化症，有茧样纤维组织包裹肠道。通过中线切口转为开腹手术进行肠粘连松解和纤维组织切除。
包裹性腹膜硬化症（EPS）是一种罕见疾病。由于围绕肠袢的坚硬包膜，症状包括反复出现的闭塞症状。这种病理情况的发病率尚不清楚。EPS常与腹膜透析（PD）、感染和全身性炎症性疾病相关。像我们患者这样的特发性病例，术前常被误诊。如果能确定病因，治疗重点在于对潜在病因的处理。对于炎症性疾病建议使用皮质类固醇，而对于腹膜透析患者则建议转为血液透析或使用他莫昔芬及免疫抑制疗法。在保守治疗方法失败或出现紧急情况时，尽管复发和死亡风险很高，仍可进行腹膜切除术和肠粘连松解术。
我们旨在描述一例被误诊为内疝的病例，以提高从业者对这种病症的认识。
