BACKGROUND Encapsulating peritoneal sclerosis(EPS)is hard to diagnose because of nonspecific symptoms and signs.It is a general consensus that EPS is classified as primary and secondary.There have been several studies...BACKGROUND Encapsulating peritoneal sclerosis(EPS)is hard to diagnose because of nonspecific symptoms and signs.It is a general consensus that EPS is classified as primary and secondary.There have been several studies discovering some highrisk factors such as liver cirrhosis,of which AMA-M2 is a biomarker,and intraabdominal surgery such as laparoscopic surgery.Imaging studies help to diagnose EPS and exploratory laparotomy might be an alternative if imaging fails.Nowadays,laparotomy plays a key role in treating EPS,especially when medical treatments do not work and medical therapy fails to ease patients’symptoms.CASE SUMMARY A 58-year-old man complained of unexplained vomiting and abdominal distension 2 mo after laparoscopic cholecystectomy.Increased alkaline phosphatase and liver enzymes were discovered.An autoimmune liver disease test showed that AMA-M2 was positive.A gastroscopy revealed bile reflux gastritis.A magnetic resonance imaging scan showed a slight dilatation of the intrahepatic bile duct.A colonoscopy showed that there was a mucosal eminence lesion in the sigmoid colon(24 cm away from the anus),with a size of 3 cm×3 cm and erosive surface.At last,the small intestine and the stomach were found to be encased in a cocoon-like membrane during the surgery.The membrane was dissected and adhesiolysis was done to release the trapped organs.The patient recovered and was discharged 44 d after the operation,and there was no recurrence during a follow-up period of 3 mo.CONCLUSION AMA-M2 is a marker of primary biliary sclerosis and may help to make a preoperative diagnosis of EPS.展开更多
基金Supported by Jiangsu Provincial Key Research and Development Plan,No.BE2018659.
文摘BACKGROUND Encapsulating peritoneal sclerosis(EPS)is hard to diagnose because of nonspecific symptoms and signs.It is a general consensus that EPS is classified as primary and secondary.There have been several studies discovering some highrisk factors such as liver cirrhosis,of which AMA-M2 is a biomarker,and intraabdominal surgery such as laparoscopic surgery.Imaging studies help to diagnose EPS and exploratory laparotomy might be an alternative if imaging fails.Nowadays,laparotomy plays a key role in treating EPS,especially when medical treatments do not work and medical therapy fails to ease patients’symptoms.CASE SUMMARY A 58-year-old man complained of unexplained vomiting and abdominal distension 2 mo after laparoscopic cholecystectomy.Increased alkaline phosphatase and liver enzymes were discovered.An autoimmune liver disease test showed that AMA-M2 was positive.A gastroscopy revealed bile reflux gastritis.A magnetic resonance imaging scan showed a slight dilatation of the intrahepatic bile duct.A colonoscopy showed that there was a mucosal eminence lesion in the sigmoid colon(24 cm away from the anus),with a size of 3 cm×3 cm and erosive surface.At last,the small intestine and the stomach were found to be encased in a cocoon-like membrane during the surgery.The membrane was dissected and adhesiolysis was done to release the trapped organs.The patient recovered and was discharged 44 d after the operation,and there was no recurrence during a follow-up period of 3 mo.CONCLUSION AMA-M2 is a marker of primary biliary sclerosis and may help to make a preoperative diagnosis of EPS.
