Sclerosing Encapsulating Peritonitis: Review

Abstract

Sclerosing encapsulating peritonitis (SEP) is a rare chronic inflammatory condition of the peritoneum with an unknown aetiology. Also known as abdominal cocoon, the condition occurs when loops of the bowel are encased within the peritoneal cavity by a membrane, leading to intestinal obstruction. Due to its rarity and non-specific clinical features, it is often misdiagnosed. The condition presents with recurrent episodes of small bowel obstruction and can be idiopathic or secondary; the latter is associated with predisposing factors such as peritoneal dialysis or abdominal tuberculosis. In the early stages, patients can be managed conservatively; however, surgical intervention is necessary for those with advanced stage intestinal obstruction. A literature review revealed 118 cases of SEP; the mean age of these patients was 39 years and 68.0% were male. The predominant presentation was abdominal pain (72.0%), distension (44.9%) or a mass (30.5%). Almost all of the patients underwent surgical excision (99.2%) without postoperative complications (88.1%).

Cocoon carcinomatosa: An unusual cause of intestinal obstruction

“…It can be either idiopathic or secondary. The pathogenesis of abdominal cocoon is theorized to be related to an increase in the release of fibrogenic cytokines resulting in deposition of fibrin-like material on the peritoneum (1). Abdominal cocoon may present with intestinal obstruction or with nonspecific symptoms like nausea, vomiting, and malnutrition.…”

“…Abdominal cocoon may present with intestinal obstruction or with nonspecific symptoms like nausea, vomiting, and malnutrition. Ultrasound or computed tomography can be used for diagnosis, and scans will reveal a thick membrane-like covering around loops of the small intestine (1,2). Surgical intervention with resection of the membrane and adhesiolysis is the usual treatment.…”

The diagnostic and therapeutic management of a peculiar case of rectal submucosal adenocarcinoma

“…Although multiple biopsies were performed, histopathological results indicated villous adenoma with various grades of epithelial dysplasia, and for this reason the standard oncologic guidelines with preoperative radiotherapy could not be followed (16,17).…”

“…and autoimmune diseases such as sarcoidosis or systemic lupus erythematosus (17,20). A high clinical presumption associated with imaging techniques, especially CT-scan, have a major role in establishing the definitive diagnosis (17).…”

“…A high clinical presumption associated with imaging techniques, especially CT-scan, have a major role in establishing the definitive diagnosis (17). At this moment, SEP is classified as primary (or idiopathic) SEP or secondary SEP, depending on the cause and on the histopathological aspects of the encapsulating membrane (21)(22)(23).…”