Sclerosing encapsulating peritonitis presenting as acute-on-chronic small-bowel obstruction in a patient with history of peritoneal carcinomatosis

Abstract

Sclerosing encapsulating peritonitis (SEP) is a whitish fibrous envelope that encapsulates intra-abdominal peritonealized organs. Although it pathophysiology is not well understood, several possible causes have been reported in the literature, including peritoneal dialysis, past abdominal surgeries, peritonitis, beta-blockers and peritoneal carcinomatosis (PC). Some idiopathic cases, with no apparent causes, were described. We present a SEP case in a 43-year-old woman with a surgical history of pancreatic and liver resection for metastatic pseudopapillary pancreatic tumor, followed by several peritonectomies for PC. She was admitted for acute-on-chronic small-bowel obstruction that did not resolve with conservative management. Surgical exploration revealed a fibrous sheath covering the small-bowel. Extensive dissection, along with small-bowel segmental resection and anastomosis, was performed. The specimen was cancer-free. The mechanism through which SEP develops in certain surgical patients is still unknown. This report presents a case of successful surgical management and a review of the literature.

Sclerosing encapsulating peritonitis causing fatal bowel obstruction

“…This is the first reported case of SEP in a patient with a history of colon and cervical cancers. While there was no clinical evidence of local recurrence, SEP could be a new presentation of peritoneal metastases from either of these cancers, as seen in previous case reports 22 26–28…”

Case Report: Abdominal Cocoon

“…Secondary can be related to presence of a VP shunt, patients on peritoneal dialysis and etc [3][4][5]. In the disease which is quiet a rare variant where the small bowel is encapsulated with a thin jelly like membrane causing obstruction of small bowel [5].…”