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.

Idiopatic Sclerosing Encapsulating Peritonitis

“…association with congenital fetal dysplasia, vascular anomalies, or the influence of cytokines and fibroblasts in chronic peritoneal fibrosis processes, such as cases of viral infection due to retrograde menstruation and retrograde peritonitis through the uterine tubes 1,6,10,16 . However, about 75% of cases of idiopathic SEP occur in individuals without these conditions, contradicting such claims 5,9,17 .…”

“…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 .…”

“…Nonspecific clinical presentations hinder the diagnosis before surgery, and for this reason, it is necessary to suspect this pathology in cases with unclear and undefined symptoms to avoid unnecessary measures and unexpected findings during intraoperative procedures 16,18 .…”

“…In case of failure of conservative therapy, recurrent cases of intestinal obstruction, or situations with clinical deterioration and organ dysfunction, surgical correction through laparotomy is indicated 7,16 .…”

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.…”