Sclerosing encapsulating peritonitis: Imaging findings in an uncommon entity

Grove, Roy López; Martinez, Agustina Heredia; Aineseder, M.; Paula, Juan A. De; Ocantos, Jorge

doi:10.1016/j.rxeng.2019.05.004

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…Patients may be asymptomatic or present with nonspecific symptoms, such as intermittent abdominal discomfort and pain, fever, ascites, anorexia, and weight loss 5,9,10 . Later, with disease progression and increased encapsulation of the intestine and intracavitary organs, symptoms related to partial or complete intestinal obstruction may arise, such as severe abdominal pain, nausea, vomiting, diarrhea, or constipation, palpable mass, and malnutrition 9,16,22 . A more severe can be observed in some rarer situations, with intestinal perforation and sepsis requiring immediate surgical intervention 1,10,23 .…”

Section: Discussionmentioning

confidence: 99%

“…In asymptomatic patients without signs of intestinal obstruction, the use of immunosuppressants such as colchicine, an mRNA expression inhibitor with antiinflammatory properties, and azathioprine, a purine synthesis inhibitor that reduces the inflammatory process, is recommended 5,18,27,28 . In cases in which patients have advanced peritoneal fibrosis, anti-fibrotic therapy in addition to the administration of immunosuppressants is necessary, usually Tamoxifen, a selective estrogen receptor whose main function is to inhibit the production of fibroblasts 15,22,26 . In refractory cases, the administration of corticosteroids is suggested to inhibit collagen synthesis and maturation of the encapsulating membrane, as well as to suppress the inflammatory process in the peritoneum 5,27 .…”

Section: Discussionmentioning

confidence: 99%

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Idiopatic Sclerosing Encapsulating Peritonitis

Pedro Carvalho,

Lousado Almeida,

Duran Barretto

et al. 2023

Relatos Casos Cir.

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Introduction: Sclerosing Encapsulating Peritonitis (SEP) is a rare syndrome characterized by a chronic inflammatory process that leads to the formation of a thick fibrocollagenous membrane that surrounds and entraps intra-abdominal organs. As a result, although some cases may be asymptomatic, patients commonly develop symptoms of intestinal obstruction, and the diagnosis is often made incidentally during intra-abdominal surgeries. Case report: A 37-year-old male patient, a chronic alcoholic, was admitted with severe abdominal pain for seven days associated with abdominal distension, anorexia, and fever. Abdominal examination revealed signs of peritoneal irritation. Chest X-ray and abdominal computed tomography showed pneumoperitoneum and a large fluid collection, with signs of wall thickening extending through the pelvic cavity, parietocolic gutters, anterior abdominal cavity, and hepatodiaphragmatic space, causing compression of the hepatic parenchyma and displacement of intestinal loops. Due to these findings, the patient underwent an emergency exploratory laparotomy, in which a fibrocollagenous membrane, extensive bowel obstruction, and an abscess were identified. A total of 4.5 liters of purulent secretion were drained, the fibrous membrane was excised, the abdominal cavity was copiously washed, and a drain was placed in the upper right quadrant. He had a satisfactory resolution of the condition, without postoperative complications, and was discharged 11 days after the procedure. Conclusion: Initially, conservative management should be prioritized due to the technical difficulty of surgery and possible complications. However, in case of greater the level of peritoneal involvement and tissue adhesion, there is a higher chance of failure of conservative management, and surgical intervention may become necessary. Keywords: Peritonitis. Fibrosis Peritoneal. Intestinal Obstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Idiopatic Sclerosing Encapsulating Peritonitis

Pedro Carvalho,

Lousado Almeida,

Duran Barretto

et al. 2023

Relatos Casos Cir.

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“…There have been case reports of SEP, including imaging or observational studies. 7 , 8 SEP can occur in all age groups and the oldest patient reported in the literature was 90 years old. 9 The most common manifestation of SEP is small intestinal obstruction, which accounts for two thirds of the patients.…”

Section: Discussionmentioning

confidence: 99%

Sclerosing encapsulating peritonitis: three case reports and review of the literature

Zhang

2020

J Int Med Res

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Sclerosing encapsulating peritonitis (SEP) is a disease that is rarely encountered clinically. Preoperative diagnosis of SEP can be difficult. However, with imaging technology, such as computed tomography (CT), this condition can be diagnosed without surgery and pathological analysis. SEP is characterized by small intestine being partially or completely encased by a layer of a thick grayish-white fibrocollagenous membrane similar to a cocoon. The most common symptoms of SEP are abdominal pain, nausea, and vomiting. SEP often leads to intestinal obstruction. Our hospital treated three emergency patients who complained of acute or chronic abdominal pain. CT showed “cauliflower sign” in two cases. The three patients were diagnosed with SEP intraoperatively. In a female patient with ascites, the situation was extremely serious, and this condition had not been reported in detail previously. Fortunately, all patients were discharged without complications. We should pay special attention to patients with SEP who have ascites, which indicates a serious situation.

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