Idiopathic Sclerosing Encapsulating Peritonitis in a Patient with Atypical Symptoms and Imaging Findings

Wetherell, Joseph; Woolley, Katherine; Chadha, Rishi; Kostka, Julia; Adilovic, Edin; Nepal, Pankaj

doi:10.1155/2021/6695806

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…The pathophysiology of SEP has been reported as four different stages: a presclerosing encapsulating peritonitis, an inflammatory phase, a progressive phase, and a fibrotic phase. The fibrotic phase has been affiliated with the formation of a thick fibrotic membrane encasing the abdominal content and causing small bowel obstruction as in our case [ 4 ].…”

Section: Discussionmentioning

confidence: 94%

“…Clinical symptoms are nonspecific and include abdominal pain, abdominal fullness, nausea, vomiting, anorexia, pyrexia, change in bowel habit, and intestinal obstruction, which makes preoperative diagnosis difficult [ 4 ]. However, with the arrival of latest imaging technology like high-resolution CT or magnetic resonance imaging, distinguishing SEP from other peritonitis seems possible [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

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Sclerosing Encapsulating Peritonitis: Solving the Diagnosis Challenge of a Rare Entity

Rahali,

Aboulfath,

Njoumi

et al. 2023

Case Reports in Surgery

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Sclerosing encapsulating peritonitis (SEP) is an unusual fibroinflammatory disease of the peritoneum marked by the development of a fibrous membrane enveloping generally the small intestines. The knowledge around this subject is not completely understood. And the etiology can be either idiopathic or secondary to several diseases, treatments, and/or medications. We present a case of a 52-year-old man suffering from atypical clinical symptoms including recurrent abdominal ascites and intestinal obstruction. An abdominal computed tomography showed findings typical of SEP. Therefore, the patient benefited from exploratory laparotomy, which confirmed the diagnosis of idiopathic SEP. Postoperatively, he again had an episode of bowel obstruction, but this was controlled with steroids. Diagnosis of SEP is a real challenge to surgeons, gastroenterologists, and radiologists. And imagery is very helpful to make the diagnosis. Consequently, it is imperative that all hospital practitioners should distinguish between this lesion and other etiology of acute peritonitis.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Sclerosing Encapsulating Peritonitis: Solving the Diagnosis Challenge of a Rare Entity

Rahali,

Aboulfath,

Njoumi

et al. 2023

Case Reports in Surgery

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“…In asymptomatic patients without signs of intestinal obstruction, the use of immunosuppressants such as colchicine, an mRNA expression inhibitor with antiinflammatory properties, and azathioprine, a purine synthesis inhibitor that reduces the inflammatory process, is recommended 5,18,27,28 . In cases in which patients have advanced peritoneal fibrosis, anti-fibrotic therapy in addition to the administration of immunosuppressants is necessary, usually Tamoxifen, a selective estrogen receptor whose main function is to inhibit the production of fibroblasts 15,22,26 . In refractory cases, the administration of corticosteroids is suggested to inhibit collagen synthesis and maturation of the encapsulating membrane, as well as to suppress the inflammatory process in the peritoneum 5,27 .…”

Section: Discussionmentioning

confidence: 99%

Idiopatic Sclerosing Encapsulating Peritonitis

Pedro Carvalho,

Lousado Almeida,

Duran Barretto

et al. 2023

Relatos Casos Cir.

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Introduction: Sclerosing Encapsulating Peritonitis (SEP) is a rare syndrome characterized by a chronic inflammatory process that leads to the formation of a thick fibrocollagenous membrane that surrounds and entraps intra-abdominal organs. As a result, although some cases may be asymptomatic, patients commonly develop symptoms of intestinal obstruction, and the diagnosis is often made incidentally during intra-abdominal surgeries. Case report: A 37-year-old male patient, a chronic alcoholic, was admitted with severe abdominal pain for seven days associated with abdominal distension, anorexia, and fever. Abdominal examination revealed signs of peritoneal irritation. Chest X-ray and abdominal computed tomography showed pneumoperitoneum and a large fluid collection, with signs of wall thickening extending through the pelvic cavity, parietocolic gutters, anterior abdominal cavity, and hepatodiaphragmatic space, causing compression of the hepatic parenchyma and displacement of intestinal loops. Due to these findings, the patient underwent an emergency exploratory laparotomy, in which a fibrocollagenous membrane, extensive bowel obstruction, and an abscess were identified. A total of 4.5 liters of purulent secretion were drained, the fibrous membrane was excised, the abdominal cavity was copiously washed, and a drain was placed in the upper right quadrant. He had a satisfactory resolution of the condition, without postoperative complications, and was discharged 11 days after the procedure. Conclusion: Initially, conservative management should be prioritized due to the technical difficulty of surgery and possible complications. However, in case of greater the level of peritoneal involvement and tissue adhesion, there is a higher chance of failure of conservative management, and surgical intervention may become necessary. Keywords: Peritonitis. Fibrosis Peritoneal. Intestinal Obstruction.

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“…In addition, early testing of his large volume ascites revealed an elevated SAAG, which is most often caused by liver disease, but in this case, was likely due to prehepatic vascular compression by thickened peritoneum. Low SAAG ascites are sometimes seen with SEP and this type of portal vascular compression is not readily identified on CT. 3,4 In this case, the subsequent development of low SAAG ascites may have been the result of an increased burden of malignant and inflammatory cells in the peritoneum.…”

Section: Commentarymentioning

confidence: 91%

An encompassing issue

Finnegan

Glass

Mookherjee

2022

Journal of Hospital Medicine

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A thorough history to guide further work-up should include bowel habits, stool character, a detailed description of any abdominal pain, and the presence of associated fevers, chills, night sweats, or weight changes. He reported several weeks of early satiety and postprandial vomiting with 40 pounds of unintentional weight loss. He noted the recent onset of urinary urgency and straining to pass bowel movements. He denied fevers, chills, night sweats, hematochezia, and melena. A work-up had been initiated at a different clinic 1 month prior. Abdominal computed tomogram (CT) had shown large volume ascites, a small left pleural effusion, mesenteric fat stranding, omental nodularity, and a normal appearing liver. Abdominal ultrasound with doppler had shown a patent portal venous system and hepatic vein. Platelet count, albumin, and international normalized ratio (INR) were normal. Alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA-19) were normal. The tuberculosis interferon-gamma release assay (IGRA) was negative. Hepatitis viral serologies were nonreactive. He had been started on diuretics and had three serial paracenteses with the removal of 1.5, 3.75, and 4 L of ascites. Ascitic fluid was hazy and yellow, and there were 779 nucleated cells/mm 3 (97% lymphocytes). Ascitic bacterial cultures were negative. The serum-ascites albumin gradient (SAAG) was 1.4 g/dl.Cytology showed mature lymphocytes.

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Idiopathic Sclerosing Encapsulating Peritonitis in a Patient with Atypical Symptoms and Imaging Findings

Cited by 5 publications

References 15 publications

Sclerosing Encapsulating Peritonitis: Solving the Diagnosis Challenge of a Rare Entity

Sclerosing Encapsulating Peritonitis: Solving the Diagnosis Challenge of a Rare Entity

Idiopatic Sclerosing Encapsulating Peritonitis

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