Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2021; 9(21): 6138-6144
Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.6138
Encapsulating peritoneal sclerosis in an AMA-M2 positive patient: A case report
Min-Yue Yin, Li-Juan Qian, Li-Ting Xi, Yi-Xing Yu, Yu-Qi Shi, Lu Liu, Chun-Fang Xu
Min-Yue Yin, Li-Juan Qian, Li-Ting Xi, Yi-Xing Yu, Yu-Qi Shi, Lu Liu, Chun-Fang Xu, Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Author contributions: Yin MY contributed to the conception of this case report, searching the relevant literature, and drafting the article; Xi LT helped to draft the article and make an initial modification; Qian LJ and Yu YX contributed to providing intraoperative pictures and critical images; Shi YQ and Liu L contributed to obtaining the written informed consent and helping search the relevant literature; Xu CF made the final revision and provided the fund support.
Supported by Jiangsu Provincial Key Research and Development Plan, No. BE2018659.
Informed consent statement: Written informed consent for the publication of this report and any accompanying images was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Chun-Fang Xu, MD, PhD, Doctor, Professor, Department of Gastroenterology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215006, Jiangsu Province, China.
Received: March 26, 2021
Peer-review started: March 26, 2021
First decision: April 28, 2021
Revised: May 7, 2021
Accepted: May 24, 2021
Article in press: May 24, 2021
Published online: July 26, 2021

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 high-risk factors such as liver cirrhosis, of which AMA-M2 is a biomarker, and intra-abdominal 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.


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.


AMA-M2 is a marker of primary biliary sclerosis and may help to make a preoperative diagnosis of EPS.

Keywords: Encapsulating peritoneal sclerosis, AMA-M2, Primary biliary cirrhosis, Biomarker, Case report

Core Tip: Encapsulating peritoneal sclerosis (EPS) is a kind of occult and potentially dangerous disease that is hard to diagnose and cure. The specific etiology of EPS is still a mystery, but there have been several cases indicating that liver cirrhosis is a high-risk factor for EPS. This article aims to emphasize that AMA-M2, which is a biochemical marker of primary biliary cirrhosis, is possible for preoperative diagnosis of EPS.