• Kanako Watanabe-Kusunoki, Yoshihiro Kusunoki, Junichi Goto, and Kazutaka Kukita.
• Department of Internal Medicine, Kushiro Red Cross Hospital, Kushiro, Japan.
• Medicine (Baltimore). 2021 Dec 23; 100 (51): e28350e28350.

RationaleEncapsulating peritoneal sclerosis (EPS), or abdominal cocoon, is a rare but fatal syndrome characterized by intestinal obstruction owing to adhesions in a diffusely thickened peritoneum. Long-term peritoneal dialysis (PD) for more than 5 years is commonly associated with EPS, while liver cirrhosis also carries a risk of EPS. However, there have been only a few reports that describe a case of EPS complicated with both cirrhosis and PD. We herein describe a case of advanced liver cirrhosis with end-stage renal disease (ESRD) who developed EPS after 4 years of PD and who was successfully recovered by surgery.Patient ConcernsA 58-year-old man with alcoholic liver cirrhosis suffered abdominal pain. The patient had a 4-year history of continuous cycling PD to manage ESRD as well as cirrhotic complications of refractory ascites and hypotension. Laboratory test results showed increased levels of inflammation, and contrast-enhanced computed tomography scan showed dilated loops of small bowel proximal to the site of intestinal obstruction. The patient was suspected to have developed intestinal obstruction owing to EPS. The patient discontinued continuous cycling peritoneal dialysis and switched to hemodiafiltration.DiagnosesLaparoscopy revealed a whitish membranous material wrapped around the bowel, especially at the terminal ileum with a narrowed portion, consistent with EPS.InterventionsRepeated decortication of fibrous peritoneal membranes successfully released the intestinal obstruction.OutcomesThe postoperative course went well and abdominal pain remained in remission. Because abdominal distension owing to ascites got intolerable in a few days after surgery, a PD catheter was re-inserted and ascitic fluid drainage was resumed with peritoneal lavage. The patient continued hemodiafiltration using vasopressor agents.LessonsThe Cirrhotic patient with ESRD undergoing PD could develop EPS after a short duration of PD.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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