Sclerosing encapsulated peritonitis
Patient had hysterectomy 1 year back, with continuous post-operative purulent discharge for 2 months. After that, laparotomy done, and a retained peice of gauze was found. Wound did not heal completely for one year. Patient presented with abdominal distension and intestinal obstruction.
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A large well encapsulated ascitic collection was seen, compressing, partially encasing and displacing adjacent bowel loops and retroperitoneal structure. Inferiorly, capsule is limiting the extent of it in pelvis. No free fluid is seen in pelvis. Capsule shows mildly enhancing thick irregular wall at few places. Multiple bowel adhesions with abdominal wall heterogeneity is seen at the scar site (infraumbilical).
Laparotomy was done and ~8 L of blood and pus mixed with serous fluid was drained. There was a thick fibrotic capsule. Bowel appeared matted, with multiple adhesions at the scar site.