Intestinal Obstruction Due to Idiopathic Sclerosing Encapsulating Peritonitis: A Case Report

Abstract

Introduction: Sclerosing encapsulating peritonitis (SEP) is characterized by partial or complete encasement of small intestine by a thick fibrocollagenous membrane. Depending on underlying causes, SEP is divided into primary and secondary forms. Idiopathic SEP is also called idiopathic or abdominal cocoon syndrome. Herein we presented a case of idiopathic SEP.

Case presentation: A 90-year-old male patient presented to our emergency department with signs and symptoms of intestinal obstruction and dehydration. Physical examination findings, patient's age and plain abdominal radiography were consistent with tumoral obstruction or viscus perforation. Explorative laparotomy revealed a fibrous capsule encasing intestines as well as dense adhesions between intestinal loops. Since the overall condition of the patient was not well enough to allow a wide dissection and membrane excision, the operation was terminated after performing a limited loop ileostomy. Unfortunately, the patient was lost due to organ failure at the postoperative period.

Conclusions: Despite advances in radiological techniques, the exact diagnosis in many cases is still made according to intraoperative findings and histopathological properties of the excised membrane. While some cases of SEP remain asymptomatic for years, most cases are characterized by recurrent bouts of acute, subacute or chronic intestinal obstruction. To our knowledge, the case presented here is the oldest patient with idiopathic SEP in the literature.

Keywords: Abdomen; Encapsulating Peritoneal Sclerosis; Intestinal Obstruction.

Figure 1.. X-Ray Plain Abdominal Radiography Revealed Intestinal Obstruction With Small Bowel Air-Fluid Levels

Figure 2.. Intraoperative Photography Showing Encapsulated Small Bowel (Cocoon Like Dense Fibrous Membrane)