Sclerosing Encapsulating Peritonitis: A Rare Cause of Bowel Obstruction

Abstract

Sclerosing encapsulating peritonitis (SEP), also referred to as abdominal cocoon syndrome, is a rare cause of bowel obstruction characterized by a thickened fibrous peritoneum that encapsulates the intestines. The exact etiology is idiopathic but may be associated with long-term peritoneal dialysis (PD). In the absence of risk factors for adhesive disease, preoperative diagnosis can be difficult and may require operative intervention or advanced imaging to diagnose. Thus, the inclusion of SEP in the differential diagnosis for bowel obstruction is essential for early detection. Existing literature is focused on renal disease as an origin, but it can be multifactorial. Here, we discuss a case of sclerosing encapsulating peritonitis in a patient without known risk factors.

An Idiopathic Case of Sclerosing Encapsulating Peritonitis: A Case Report

“…The clinical presentation of sclerosing encapsulating peritonitis is notably nonspecific, often mirroring other more common causes of intestinal obstruction [ 2 , 3 ]. This nonspecificity, coupled with the rarity of the condition, frequently results in significant diagnostic delays.…”

“…Sclerosing encapsulating peritonitis, or abdominal cocoon syndrome, is characterized by thick fibrous encapsulation of the small bowel, leading to symptoms of intestinal obstruction [1]. Although the pathogenesis of sclerosing encapsulating peritonitis is poorly understood, its association with peritoneal dialysis, abdominal surgery, tuberculosis, and certain autoimmune conditions suggests a multifactorial etiology involving both acquired and inherent predispositions [2][3][4]. The idiopathic form of sclerosing encapsulating peritonitis underscores the diagnostic and therapeutic challenges inherent to conditions with obscure etiologies.…”

“…The management of sclerosing encapsulating peritonitis remains controversial, with options ranging from conservative approaches, including nutritional support and anti-inflammatory medications, to surgical intervention [2][3][4]. Surgical management, typically involving the removal of the fibrous capsule, is indicated in patients with intestinal obstruction or failure of conservative treatment [4,5].…”

“…Sclerosing encapsulating peritonitis, also known as abdominal cocoon syndrome, is a rare condition characterized by the development of a thick fibrous membrane that encases the small bowel, leading to intestinal obstruction and a variety of nonspecific abdominal symptoms [1]. Although it has been associated with peritoneal dialysis, previous abdominal surgery, tuberculosis, and certain autoimmune conditions, sclerosing encapsulating peritonitis remains an entity with an elusive etiology in many cases [1][2][3]. The idiopathic form of the disease, where no underlying cause can be identified, presents a particular challenge for diagnosis and management [2,3].…”

“…Although it has been associated with peritoneal dialysis, previous abdominal surgery, tuberculosis, and certain autoimmune conditions, sclerosing encapsulating peritonitis remains an entity with an elusive etiology in many cases [1][2][3]. The idiopathic form of the disease, where no underlying cause can be identified, presents a particular challenge for diagnosis and management [2,3].…”