Liver Cirrhosis With Encapsulating Peritoneal Sclerosis: A Case Report

A 72-year-old male with a history of alcohol use disorder complicated by cirrhosis and chronic thrombocytopenia, hypertension, chronic back pain, a congenital solitary kidney, and active tobacco use presented with a one-year history of intermittent right upper quadrant pain. Preoperative evaluation suggested symptomatic cholelithiasis, and he was brought to the operating room for laparoscopic cholecystectomy. Intraoperatively, dense, fibrotic tissue approximately 1-2 cm thick was found encasing the liver, with similar deposits over the antimesenteric surface of the colon, scattered stippling across the peritoneum, and a 1 cm nodule attached to the anterior abdominal wall peritoneum in the right upper quadrant. Given these unexpected findings, the cholecystectomy was deferred, and biopsies were obtained. Histopathological analysis revealed peritoneal sclerosis. Encapsulating peritoneal sclerosis is a rare condition most commonly seen in small-bowel involvement among post-transplant patients following peritoneal dialysis. We report this unusual case of advanced sclerosing peritonitis primarily affecting the hepatic surface in a patient without any history of peritoneal dialysis or transplantation. This unique presentation underscores the importance of further investigation into the pathophysiology and clinical spectrum of this rare entity.