Encapsulating peritoneal sclerosis

Case contributed by Dr Vikas Shah

Presentation

Peritoneal dialysis many years earlier. Vague abdominal discomfort.

Patient Data

Age: 40 years
Gender: Female

Abdominal x-ray

X-ray

Sheet-like calcification across the upper and mid abdomen. Extensive arterial calcification. Multiple surgical clips in left iliac fossa; there was an undisclosed history of a renal transplant. No signs of bowel obstruction.

Case Discussion

Encapsulating peritoneal sclerosis may be a complication of peritoneal dialysis. Chronic inflammation leads to thickening and calcification of the peritoneum, forming a calcified cocoon encasing the bowel and leading to subacute bowel obstruction. There are features here that make it a great exam film:

  1. the cause of renal failure: diabetes leading to extensive arterial calcification
  2. the previous treatment for the renal failure was peritoneal dialysis, leading to the calcification
  3. the most recent treatment is a transplant, evidenced by the surgical clips in the left iliac fossa

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