Sclerosing encapsulating peritonitis presenting with paroxysmal abdominal pain and strangulated mechanical bowel obstruction

Abstract

Rationale: Sclerosing encapsulated peritonitis (SEP) is a rare chronic peritoneal inflammation with unknown etiology, and is also known as abdominal cocoon. This occurs when the intestinal annulus is enveloped in the peritoneal cavity, resulting in intestinal obstruction. Its preoperative diagnosis and treatment strategy remains a challenge. Patient concerns: The study reports a 53-year-old male, who presented with a 4-day history of paroxysmal abdominal pain, without the adverse reaction of nausea, vomiting, or diarrhea. Diagnosis: The accurate diagnosis of SEP was made after the emergency diagnostic laparoscopy. Interventions: The laparoscopic exploration revealed that the small intestine was wrapped by a layer of peritoneum. Then, the abdominal fibrous membrane was removed surgically, and adhesiolysis were performed. The patient recovered well, and gradually recovered by the 10th post-operative day. Outcomes: The patient was discharged uneventfully after 10 days, and the patient recovered well. After the 12-month follow-up, no symptoms of recurrence or complications were observed. Lessons: The preoperative diagnosis of SEP remains difficult, and the onset of SEP has exhibited a younger trend. The diagnosis of SEP should remain on the list of differential diagnosis for paroxysmal abdominal pain. single-photon emission computed tomography/computed tomography and laparoscopic exploration have been proven to be helpful for establishing the diagnosis. In the early stage of intestinal obstruction caused by SEP, surgical intervention was immediately carried out in emergency department, and the patient recovered well after the operation. The present study also presents a review of the literature for other cases of SEP. The external evidence was helpful in making clinical decisions for patient care.

Primary Sclerosing Encapsulating Peritonitis (PSEP) With Meckel’s Diverticulum: A Rare Case Report

“…The present case is of a young adolescent female who was diagnosed with PSEP with subacute intestinal obstruction. It is difficult to obtain a pre-operative diagnosis due to the non-specific clinical manifestations [8]. In the present case, the diagnosis was established intraoperatively.…”

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.…”

“…Imaging, particularly computed tomography, plays a pivotal role in the diagnosis of sclerosing encapsulating peritonitis, as evidenced in this case by the identification of the characteristic "cocoon-like" encapsulation of the small bowel [ 3 - 5 ]. These imaging modalities not only facilitate diagnosis but also aid in the planning of surgical intervention by delineating the extent of peritoneal involvement [ 4 , 5 ].…”

“…Imaging studies, particularly computed tomography (CT), play a crucial role in identifying the characteristic features of sclerosing encapsulating peritonitis [ 1 ]. Treatment strategies vary from conservative management with nutritional support and anti-inflammatory medications to surgical intervention when bowel obstruction occurs [ 3 , 4 ]. The complexity of sclerosing encapsulating peritonitis calls for a multidisciplinary approach to optimize outcomes for affected individuals.…”

Abdominal Cocoon With Intestinal Perforation: A Case Report

“…The abdominal cocoon disease is a rare peritoneum disease, which is characterized by a dense layer of gray-white membranous fibrous connective tissue wrapping some or all of the abdominal organs, similar to the cocoon of a silkworm. Because of the lack of specificity in the clinical manifestations, it is difficult to differentiate from the intestinal obstruction, perforation, or abdominal mass caused by the other reasons, so the preoperative diagnosis is more difficult, and the diagnosis is majorly based on the intraoperative findings (3,4). The patient underwent an emergency operation because of the gastrointestinal perforation, and the abdominal cocoon was found during the operation.…”