Primary sclerosing encapsulating peritonitis: a case report 

Abstract

Background Sclerosing encapsulating peritonitis is a rare condition with a typical macroscopic appearance, with fibrocollagenous membrane enclosing loops of the small intestine, causing intestinal obstruction. Unexplained recurrent abdominal pain, obstruction, and a large array of other possible clinical signs and symptoms make sclerosing encapsulating peritonitis a diagnostic challenge. Case presentation A 48-year-old man of Persian ethnicity was admitted multiple times to the emergency surgery department due to recurrent sudden abdominal pain and chronic obstruction without significant findings in medical history or clinical evaluation. Computed tomography was positive for proximal jejunal dilatation and duodenojejunal flexure stenosis due to internal mesenteric hernia. Exploratory laparoscopy, followed by laparotomy, confirmed thick membrane-like fibrous tissue with complete small intestinal loop envelopment. Extensive membrane excision and adhesiolysis was performed, but no mesenteric herniation was found. Early postoperative paralytic ileus with introduction of low-dose steroid therapy, based on histopathological and immunological results, confirming type III sclerosing encapsulating peritonitis, was completely resolved. Conclusion Sclerosing encapsulating peritonitis is a rare and difficult-to-diagnose condition, further divided into primary and secondary sclerosing encapsulating peritonitis, on the basis of underlying etiology, dictating treatment modality and prognosis. Intraoperative diagnosis and surgical treatment are mandatory, besides a wide variety of abdominal computed tomography scans, inconclusive results, and clinical presentations. There are so far no known specific markers for the diagnosis of sclerosing encapsulating peritonitis.

Primary abdominal cocoon syndrome manifesting with Chilaiditi syndrome and intestinal obstruction: A case report

“…In another case report by Pintar et al., a case of ACS was presented with chronic abdominal pain and his abdominal CT scan was suggestive for mesenteric hernia; however, the intraoperative diagnosis was changed to ACS. 15 Considering the acute onset and severe condition of our patient, we proceeded with the surgical approach without abdominal CT scan and reached a favorable outcome including the resolution of all symptoms and more than 30% weight gain in long‐term follow‐up.…”

Chronic Encapsulated Sclerosing Peritonitis: A Case Report

“…CESP is a chronic inflammatory condition that causes peritoneal thickening due to the formation of a membrane of collagen and fibrous tissue that surrounds the loops of the small intestine. According to the studies carried out, CESP can be classified as primary (idiopathic) or secondary [3,4].…”

“…In idiopathic or primary CESP, hypoplasia of the greater omentum and malformation of mesenteric vessels have been discussed as risk factors. On the other hand, extensive endometriosis and the role of prostaglandin E2 and its relationship with the protease-activated receptor (PAR) have been described in women [4,5]. This can be classified into three categories based on the extension of the peritoneal membrane over the loops of intestine: type I refers to only partially covering a part of intestinal loops, type II covers the entire loops of the small intestine, and type III involves the entire loops of the small intestine and other organs (appendix, cecum, ascending colon, stomach, liver, and ovaries) [3].…”