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Data from the microbiology, pathology and radiology investigations lead to no diagnosis. Eventually, laparoscopy revealed the diagnosis of EPS. Treatment with tamoxifen to counteract fibrosis and a pulse dose of methylprednisolone was started. Unfortunately, the patient developed a bowel perforation and died. In retrospect, the radiological sign of a cocoon encasing the small bowels should have been a clue to an early diagnosis.<\/jats:p>","DOI":"10.1136\/bcr-2024-264334","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T12:11:45Z","timestamp":1737979905000},"page":"e264334","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Unexpected finding of encapsulating peritoneal sclerosis: mind the cocoon"],"prefix":"10.1136","volume":"18","author":[{"given":"Eva","family":"van Boven","sequence":"first","affiliation":[{"name":"Erasmus MC Universitair Medisch Centrum Rotterdam, Rotterdam, Zuid-Holland, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert R J","family":"Coebergh van den Braak","sequence":"additional","affiliation":[{"name":"Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"van Laar","sequence":"additional","affiliation":[{"name":"Clinical Immunology, Internal Medicine, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michiel G H","family":"Betjes","sequence":"additional","affiliation":[{"name":"Nephrology and Transplantation, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,1,27]]},"reference":[{"key":"2025082709534278000_18.1.e264334.1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfq362"},{"key":"2025082709534278000_18.1.e264334.2","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.01260209"},{"key":"2025082709534278000_18.1.e264334.3","doi-asserted-by":"publisher","DOI":"10.1159\/000348267"},{"key":"2025082709534278000_18.1.e264334.4","doi-asserted-by":"crossref","first-page":"3101","DOI":"10.3748\/wjg.v24.i28.3101","article-title":"Encapsulating peritoneal sclerosis","volume":"24","author":"Danford","year":"2018","journal-title":"World J Gastroenterol"},{"key":"2025082709534278000_18.1.e264334.5","doi-asserted-by":"crossref","first-page":"1860","DOI":"10.1007\/s00268-014-2458-6","article-title":"Surgical treatment and perioperative management of idiopathic abdominal cocoon: single-center review of 65 cases","volume":"38","author":"Li","year":"2014","journal-title":"World J Surg"},{"key":"2025082709534278000_18.1.e264334.6","doi-asserted-by":"publisher","DOI":"10.1007\/BF01299875"},{"key":"2025082709534278000_18.1.e264334.7","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.2169\/internalmedicine.9793-22","article-title":"Encapsulating Peritoneal Sclerosis in Systemic Lupus Erythematosus, Rheumatoid Arthritis, and Systemic Sclerosis","volume":"62","author":"Matsuda","year":"2023","journal-title":"Intern Med"},{"key":"2025082709534278000_18.1.e264334.8","unstructured":"Andr\u00e9s C , Gelrud A , Chopra S . 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