Background: Encapsulating peritoneal sclerosis is a rare manifestation nowadays. Case report: This was a case report of a young female with ESKD on hemodialysis for more than 6 months with a previous history of continuous ambulatory peritoneal dialysis (CAPD) and recurrent peritonitis which currently presented with painful abdominal distension. The CT scan of the abdomen showed a clumping of small bowel loops at the left side encased into a thin fibrocartilaginous membrane. Initially, she was treated for intrabdominal sepsis however after recurrent admission, IV Methylprednisolone was started followed by high dose steroids and tamoxifen as a treatment for EPS. Surprisingly she improved and had a good clinical response. She had readmitted again after a few months with abdominal pain due to an abrupt stop in steroid but improved again after the steroid was started. Conclusion: Abdominal pain in a patient with history of CAPD peritonitis needs to raise suspicion of EPS even though is rare Radiological Imaging is helpful in making early diagnosis. The most important thing is steroid as a mainstay of the treatment of EPS besides tamoxifen with a minimal one-year duration or lifelong as surgical intervention is very risky.

Keywords: encapsulating peritoneal sclerosis, peritonitis, clumping of bowel loops, tamoxifen, steroid.