A Case Report and Clinical Insights on Encapsulating Peritoneal Sclerosis: A Rare yet Critical Complication of Peritoneal Dialysis.

Peritoneal dialysis (PD) offers a valuable alternative to hemodialysis in the management of end-stage renal disease. While PD offers several advantages, such as improved patient autonomy and preservation of residual kidney functions. It has a wide spectrum of complications, which include mechanical ones such as catheter malfunction or migration, hernias and dialysate leak, or infectious complications, which can be limited to exit site and tunnel infections or extend interiorly to cause peritonitis. One detrimental long-term complication of PD is encapsulating peritoneal sclerosis (EPS), a rare condition characterized by formation of a fibrous cocoon around the bowel loops often initiated by chronic exposure to PD solutions. Other implicated factors include peritonitis, medications and systemic inflammatory conditions. Risk of EPS increases with the duration of PD, particularly after five years. Diagnosis of EPS is challenging and often delayed, given non-specific and wide spectrum of symptoms that may range from loss of appetite to frank signs of abdominal obstruction, which result in significant consequences that can lead to treatment failure and high mortality rate. Imaging in the form of a CT abdomen is the cornerstone in diagnosis, although many patients are diagnosed intraoperatively during exploratory laparotomy. Treatment is usually directed at eliminating provoking factors and directed therapy based on the disease phase.  In this case, we are discussing a 69-year-old patient presenting with signs of abdominal obstruction and found to have a large cystic lesion compressing small bowels. Eventually, patient obstruction was relieved with draining though interventional radiology after a trial of conservative management failed. Our goal is to notify our colleagues that we have a high index of suspicion coupled with prompt imaging evaluation that can facilitate early diagnosis, offering hope for improved patient outcomes through timely management strategies.