Sclerosing Encapsulating Peritonitis: A Rare Cause of Intestinal Obstruction

Abstract

Sclerosing encapsulating peritonitis (SEP) is a rare clinical entity that may cause small bowel obstruction. It is characterized by a thick fibrocollagenous cocoon-like membrane. Surgical intervention is the mainstay of treatment. A 36-year-old Pakistani man presented with recurrent attacks of colicky abdominal pain, distention, vomiting, and constipation. Abdominal CT revealed a thick enhanced membrane forming a sac that contained clusters of small intestinal loops. Exploratory laparotomy showed a thick membrane containing the small bowel and extensive inter-loop adhesions. The sac underwent decortication and excision, inter-loop adhesions were released, and an appendectomy was performed. The patient tolerated the procedure and was discharged in good condition.

Keywords: abdominal cocoon; abdominal pain; bowel obstruction; case report; sclerosing encapsulating peritonitis.

Figure 1. Abdominal CT images.

Axial (A and B) and coronal (C) contrast-enhanced CT images showing a cluster of dilated small bowel loops that are drawn into the center of the abdominal cavity, pushing the stomach (S) and transverse colon (TC) superiorly. Note enhanced thickened membrane surrounding the bowel loops (arrows) and the fecalization of small bowel content (arrowhead in C). Thickened wall appendix with surrounding fat stranding (long arrow in B).

Figure 2. Gross pathology image.

Gross pathology image showing the resected membrane around the small intestine.