Partial Small Bowel Resection for Encapsulating Peritoneal Sclerosis Secondary to Adjuvant Chemoradiotherapy of Rhabdomyosarcoma in a Young Adult: A Case Report

Abstract

Encapsulating peritoneal sclerosis (EPS) is characterized by diffuse peritoneal fibrosis, progressive intestinal encapsulation, and the clinical spectrum of intestinal obstruction. Although it is a complication of peritoneal dialysis, secondary EPS with other causes is very rare. We herein report a case of EPS secondary to adjuvant chemoradiotherapy for rhabdomyosarcoma in a 21-year-old male. Partial bladder resection and an omentectomy for stage IV rhabdomyosarcoma of the bladder with intra-abdominal bleeding were performed when he was 19 years old. He was transferred to our hospital for adjuvant chemoradiotherapy with a modified ARST0431 protocol (Children’s Oncology Group study). He developed a small bowel obstruction after 12 months of chemotherapy and 6 months of radiotherapy. Conservative treatment did not relieve the symptoms and a diagnostic laparotomy was performed. The laparotomy revealed severe adhesion between the thickened whitish peritoneum and intestines. The entire small intestine was similarly covered with a thickened, white-toned coating. We attempted to dissect the thickened coating but discontinued because the procedure easily damaged the serosa of the small intestine. We resected the ileum at the region where the adhesion and bend were too severe to dissect. The diagnosis of EPS was based on pathological findings of thickened submesothelial tissues and clinical course. Six years postoperatively, there was no recurrence of either small bowel obstruction or the tumor.