Sclerosing encapsulating peritonitis
A known case of duodenal cancer, presented with acute abdominal pain and signs of intestinal obstruction.
CT Abdomen and pelvis
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There are mildly dilated and thickened small bowel jejunal and ileal loops seen in the center of the abdominal cavity, which are enclosed within a sac formed by thickened and enhancing peritoneum. Fluid is noted within this sac, as well as free and located fluid is seen in the other peritoneal compartments of the abdominal cavity. These findings are suggestive of sclerosing encapsulating peritonitis.
Also noted multiple low-density deposits in the liver, pancreas and peritoneum suggestive of metastases.
Previously inserted duodenal stent is seen.Other findings of aerobilia in the liver and air within the gall bladder as sequelae to the duodenal stent are noted.
Sclerosing encapsulating peritonitis, previously termed abdominal cocoon, is a rare cause of acute or subacute intestinal obstruction, in which, a part of, or the entire small bowel is encapsulated within a thick fibrocollagenous membrane.
It may be idiopathic, or occur due to chronic peritoneal dialysis, peritoneal shunts, infections like tuberculosis, or gastrointestinal malignancies.
CT is the imaging modality of choice. The characteristic findings are the presence of dilated and thickened small bowel loops pushed to the center of the abdomen, and enclosed within a thick membrane. Other findings include fixation of small bowel loops, ascites and peritoneal calcifications
The differential diagnosis is an internal hernia, especially with the findings of dilated and fixed small bowel loops, and signs of intestinal obstruction. However, the lack of a membrane encasing the bowel loops helps to rule out this entity.
- Demir MK, Akinci O, Onur E et-al. Case 108: sclerosing encapsulating peritonitis. Radiology. 2007;242 (3): 937-9.
- Ti JP, Aradi A, Conlon PJ et-al. Imaging Features of Encapsulating Peritoneal Sclerosis in Continuous Ambulatory Peritoneal Dialysis Patients. AJR Americal journal of roentgenology. 2010;195(1):W50-4.