title: A case of idiopathic encapsulating peritoneal sclerosis with intractable ileus successfully treated by surgery and steroid therapy.
abstract: Encapsulating peritoneal sclerosis (EPS) occurring without a history of peritoneal dialysis is rare. We report on a patient with idiopathic EPS following intractable ileus who was successfully treated by surgery and postoperative steroid therapy without any sign of recurrence. A 67-year-old woman was referred to our department for further treatment of intractable ileus. Abdominal CT scanning revealed wall thickening of the proximal jejunum. Double-balloon enteroscopy disclosed stenosis of the jejunum at 20 cm anally from the Treitz ligament, although the intestinal mucosa appeared normal without specific biopsy findings. In addition, FDG-PET showed no abnormal accumulation, thus discounting a malignant lesion. Since conservative therapy failed to improve the ileus, we performed an operation on her in order to release the ileus and make a histological diagnosis. Surgical findings included a whitish thickening of the serosa extending to the intestine and the whole mesentery. Accordingly, we made a diagnosis of idiopathic encapsulating peritoneal sclerosis because of her negative history of peritoneal dialysis, laparotomy or peritonitis, in addition to the above-noted findings. Postoperative oral administration of steroid has suppressed EPS recurrence. In patients with intractable ileus, EPS should be added to the list of differential diagnoses, even if they have not undergone peritoneal dialysis.
authors.affiliation: Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
authors.forename: Yuuki
authors.initials: Y
authors.lastname: Ikeda
authors.affiliation: Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
authors.forename: Yuusuke
authors.initials: Y
authors.lastname: Kamihara
authors.affiliation: Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hirakawa
authors.affiliation: Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Onuma
authors.affiliation: Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
authors.forename: Kohichi
authors.initials: K
authors.lastname: Takada
authors.affiliation: Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Sato
authors.affiliation: Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Miyanishi
authors.affiliation: Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
authors.forename: Rishu
authors.initials: R
authors.lastname: Takimoto
authors.affiliation: Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Kohune
authors.affiliation: First Department of Surgery, Sapporo Medical University, Sapporo, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Nobuoka
authors.affiliation: Department of Surgical Pathology, Sapporo Medical University, Sapporo, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Noguchi
authors.affiliation: Department of Gastroenterology, Kyoritsu Gorinbashi Hospital, Sapporo, Japan.
authors.forename: Motoo
authors.initials: M
authors.lastname: Oi
authors.affiliation: Department of Gastroenterology, Kyoritsu Gorinbashi Hospital, Sapporo, Japan.
authors.forename: Hisato
authors.initials: H
authors.lastname: Honma
authors.affiliation: First Department of Surgery, Sapporo Medical University, Sapporo, Japan.
authors.forename: Kohichi
authors.initials: K
authors.lastname: Hirata
authors.affiliation: Department of Surgical Pathology, Sapporo Medical University, Sapporo, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Hasegawa
authors.affiliation: Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan. jkato@sapmed.ac.jp.
authors.forename: Junji
authors.initials: J
authors.lastname: Kato
keywords: Idiopathic encapsulating peritoneal sclerosis; Ileus; Steroid therapy; Surgery