Learning objectives
To define idiopathic sclerosing encapsulating peritonitis
To describe the radiological appearance of the dissease
To discuss the differential diagnosis with otherentities that involve the peritoneum
Background
Concept definition:
Idoipathic sclerosing encapsulating peritonitis (SEP)is a chronic inflammatory process in whichthe small intestines are encased by a dense fibrocolagenous membrane,
first defined over a 100 years ago as "peritonitis chronica fibrosa incapsulata" by Owtschinnikv and latter also namedby Foo in 1978 as "abdominal cocoon syndrome"
SEP can be divided into primary (idiopathic) or secondary forms if an underlying etiolgyis identified but until recently there has been much confusion between the names given to the dissease and terms such as abdominal cocoon,
peritoneal encapsulation...
Findings and procedure details
Radiological diagnosis:
EPS is such a rare entity,
even in its secondary form,
that there is no consensus or protocols for emergency abdominal imaging.
We here present 3 cases of surgically proven idiopatic SEP and their radiological signs and we depict radiological findings and describe the different imaging techniques used for the diagnosis of SEP in the emergengy setting.
Abdominal radiography:
Plain abdminal radiography can show air-fluid levels or bowel dilation (Fig.
6),
even peritoneal or mesenteric calcifications but abdominal X-rays can appear normal.
Given...
Conclusion
Only about 6% of gastrointestinal obstructions are caused by unusual conditions and idiopathic SEP is one of the most unusual of them.
Look out for the cauliflower sign,
thickened or enhancing peritoneum,
loculated ascites and peritoneal or mesenteric calcifications.
Although the correct diagnosis can only be achieved by intraoperative observation and histopathological examination an accurate preoperative diagnosis is vital both for accurate treatment planing and prognosis
Personal information
Dr.
Paulino García Benedito
Emergency Radiology
Hospital Universitario Puerta de Hierro
Calle Manuel de Falla,
1,
28222 Majadahonda,
Madrid
[email protected]
Dr.
Ana M.
Alcolado Jaramillo
Abdominal Radiology
Hospital Universitario Puerta de Hierro
Calle Manuel de Falla,
1,
28222 Majadahonda,
Madrid
Department of Radiology (abdominal section):
Dr.
C.
Gonzalez Hernando
Dr.
E.
van den Brule
Dr.
A.M.
Alcolado
Dr.
M.D.P.
Reyero Lafuente
Dr.
A.
Piazza Dobarganes
References
1.
Akbulut,
S.
Accurate definition and management of idiopathic sclerosing encapsulating peritonitis.
World J Gastroenterol.
2015 January 14; 21(2): 675-687
2.- Danford CJ,
Lin SC Smith MP and Wolf JL.
Encapsulating peritoneal sclerosis.
World J Gastroenterol.
2018 July; 24 (28):3101-3111
3.-Vlijm AV,
van Schuppen J,
Lamers ABGN,
Struijk DG and Krediet RT.
Imaging in encapsulating peritoneal sclerosis.
NDT Plus (2011) 4: 281-284
4.- Allam H,
Al Yahri O,
Mathew S et al.
The enigma of primary and secondary encapsulating peritoneal sclerosis.
BMC Surgery (2016) 16:...