Sclerosing encapsulating peritonitis

Case contributed by Dr Kavitha Nair

Presentation

A known case of duodenal cancer, presented with acute abdominal pain and signs of intestinal obstruction.

Patient Data

Age: 50
Gender: Female
CT

CT Abdomen and pelvis

There are mildly dilated and thickened small bowel jejunal and ileal loops seen in the centre 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.

 

Case Discussion

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 centre 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.

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Case information

rID: 46214
Case created: 27th Jun 2016
Last edited: 2nd Jul 2016
Inclusion in quiz mode: Included

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