Sclerosing Encapsulating Peritonitis: Review

Abstract

Sclerosing encapsulating peritonitis (SEP) is a rare chronic inflammatory condition of the peritoneum with an unknown aetiology. Also known as abdominal cocoon, the condition occurs when loops of the bowel are encased within the peritoneal cavity by a membrane, leading to intestinal obstruction. Due to its rarity and non-specific clinical features, it is often misdiagnosed. The condition presents with recurrent episodes of small bowel obstruction and can be idiopathic or secondary; the latter is associated with predisposing factors such as peritoneal dialysis or abdominal tuberculosis. In the early stages, patients can be managed conservatively; however, surgical intervention is necessary for those with advanced stage intestinal obstruction. A literature review revealed 118 cases of SEP; the mean age of these patients was 39 years and 68.0% were male. The predominant presentation was abdominal pain (72.0%), distension (44.9%) or a mass (30.5%). Almost all of the patients underwent surgical excision (99.2%) without postoperative complications (88.1%).

Keywords: Abdominal Pain; Intestinal Diseases; Intestinal Obstruction; Membrane Tissue; Peritonitis; Sclerosis.

Figure 1A–C:

Classifications of primary sclerosing encapsulating peritonitis (SEP) into (A) type I, (B) type II and (C) type III. For types I and II, the membrane (grey shading) encloses part of and the whole of the small intestine, respectively. Type III SEP involves a membrane (grey shading) which encloses the whole of the small bowel and other organs, such as the ovaries and colon.

Figure 2A–B:

Laparotomy images revealing (A) the thick membrane (arrow) cocooning the intestine of a patient with sclerosing encapsulating peritonitis and abdominal tuberculosis and (B) multiple exposed tubercles (arrowhead) on the intestinal surface after the membrane has been excised (arrows).

Figure 3A–B:

A: Plain abdominal X-ray showing bowel wall calcification (arrow) and peritoneal calcification with centrally clumped dilated small bowel loops (arrowhead) in a patient with sclerosing encapsulating peritonitis. B: Abdominal computed tomography revealing encased loops of bowel (arrow) by a distinct membrane (arrowheads) in a patient with sclerosing encapsulating peritonitis. Figure 3A reproduced with permission from Candido PC, Werner AF, Pereira IM, Matos BA, Pfeilsticker RM, Filho RS. Sclerosing encapsulating peritonitis: A case report.