Ann Surg Treat Res.  2016 Apr;90(4):231-234. 10.4174/astr.2016.90.4.231.

Unusual intestinal obstruction due to idiopathic sclerosing encapsulating peritonitis: a report of two cases and a review

• Yang CS
• Kim D

• KMID: 2160954
• DOI: http://doi.org/10.4174/astr.2016.90.4.231

Abstract

Sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction that is characterized by a thick fibrotic membrane encasing the small intestine like a cocoon. Accurate preoperative diagnosis is often difficult. We present 2 cases of SEP that were diagnosed preoperatively by contrast-enhanced computed tomography scan. A 38-year-old man and a 56-year-old woman were admitted to Daegu Catholic University Medical Center because of recurrent intestinal obstruction. We performed exploratory laparotomy with doubt of the preoperative diagnosis of SEP. We confirmed the diagnosis of SEP on laparotomy and performed adhesiolysis. Both patients recovered successfully and had no signs of recurrence. A better awareness of SEP and its radiological features should lead to more correct preoperative diagnosis and result in more appropriate management, including surgery.

Keyword

Intestinal obstruction; Peritoneal fibrosis; Encapsulating peritoneal sclerosis; Laparotomy

MeSH Terms

Academic Medical Centers
Adult
Daegu
Diagnosis
Female
Humans
Intestinal Obstruction*
Intestine, Small
Laparotomy
Membranes
Middle Aged
Peritoneal Fibrosis
Peritonitis*
Recurrence

Figure

• 

  Fig. 1 The axial section shows marked dilatation and thickening of the small intestine, encased in a thick enhancing membrane. Fluid collection between the bowel loops is seen.

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  Fig. 2 The coronal section reveals congregated loops to the center of the abdomen by the thickened peritoneum.

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  Fig. 3 At laparotomy, the small intestine is encased in a cocoon-like fibrotic tissue.

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  Fig. 4 After peritoneal decortication, we can see the fibrous membranes.

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