Sclerosing Encapsulating Peritonitis Causing Delayed Intestinal Obstruction
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IMAGES IN SURGERY
Sclerosing Encapsulating Peritonitis Causing Delayed Intestinal Obstruction Jayakumar G 1 & Akshay Viswanath U V 1 & Amal George 1 & Sajeesh Sahadevan 2 & Shahid Shameem 1 Received: 14 May 2020 / Accepted: 22 May 2020 # Association of Surgeons of India 2020
Abstract Sclerosing encapsulating peritonitis, also known as abdominal cocoon, is a rare condition of unknown etiology which results in intestinal obstruction due to total or partial encapsulation of the small bowel by a fibrocollagenous membrane. A high index of clinical suspicion is required for preoperative diagnosis. The early clinical features are nonspecific and not recognized, which makes a definite preoperative diagnosis difficult. The radiological diagnosis of abdominal cocoon is now made on computed tomography scan. Surgery plays main role in the management of this disease. Careful dissection and excision of the thick sac with the release of the small bowel loops will lead to complete recovery in the vast majority of cases. Here, we are reporting a case of sclerosing encapsulating peritonitis presented with delayed intestinal obstruction. Keywords Peritonitis . Sclerosis . Intestinal obstruction
Case Summary This 36-year-old male patient with history of dyspepsia and loss of weight for 1-month duration now presented to emergency with bilious vomiting, abdominal distension, and constipation for 1 week. On examination his abdomen was grossly distended with a firm, non-tender mass of 30 × 20 cm size involving all regions of abdomen. CECT abdomen showed narrowing of DJ flexure, thickening, and narrowing of proximal jejunum with small bowel loops congregated to the center of abdomen (Fig. 1a and b). On proceeding with laparotomy, we found large intestinal cocoon with multiple adhesions and dilatation of proximal small bowel loops (Fig. 2a and b). Adhesiolysis done and biopsy was taken, which was later reported as sclerosing peritonitis (Fig. 2c).
* Akshay Viswanath U V [email protected] 1
Department of General Surgery, Aster Malabar Institute of Medical Sciences (MIMS), Govindapuram P.O, Calicut 673016, India
2
Department of Gastrointestinal Surgery and Liver Transplantation Unit, Aster Malabar Institute of Medical Sciences (MIMS), Calicut, India
Sclerosing encapsulating peritonitis (SEP) is a rare condition with an unknown etiology. It is characterized by a thick grayish white fibrotic membrane, partially or totally encasing the small bowel, and may extend to involve other organs like the large intestine, liver, and stomach. EP can be classified as idiopathic or secondary. Sclerosing encapsulating peritonitis (SEP) is a relatively rare cause of intestinal obstruction [1]. Clinically, it presents with recurrent abdominal pain, nausea, vomiting, anorexia, weight loss, malnutrition, recurrent episodes of acute, subacute or chronic small bowel, incomplete or complete obstruction, and at times with a palpable soft non tender abdominal mass. But sometimes, patient can be asymptomatic. The exact diagnosis of this entity is made by compu
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