Sclerosing encapsulating peritonitis: a radiological diagnosis with surgical significance.

Congress:

ECR 2020

Poster Number:

C-12923

Type:

Educational Exhibit

Keywords:

Not applicable, Pathology, Obstruction / Occlusion, Infection, Surgery, Contrast agent-oral, Contrast agent-intravenous, CT-Enterography, CT, Small bowel, Peritoneum, Abdomen, GI Tract

Authors:

C. D. wadhwani¹, S. V. DESHMUKH ²; ¹Pune, gu/IN, ²Pune/IN

DOI:

10.26044/ecr2020/C-12923

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-12923

Fig. 1: Pupa inside a cocoon resemble the bowel within the capsule in SEP hence called...

Fig. 2: Concertina- a free reed instrument. it consists of expanding and contracting...

Fig. 3: Erect Abdomen Xray in a 28 year old male with past history of umbilical hernia...

Fig. 5: Positive oral contrast image in a 28 year old male with SEP shows a...

Fig. 6: Volume rendered 3D coronal image in 28 year old with SEP after administration...

Fig. 7: SEP in a 30 year old male on anti-tubercular regimen(AKT). Coronal CECT image...

Fig. 17: 38 year old treated case of abdominal tuberculosis, on CT imaging was advised...

Learning objectives

To familiarize with the multimodality imaging features of a rare entity- sclerosing encapsulating peritonitis(SEP). To discuss the complications and management options available with timely diagnosis of SEP.

Background

Sclerosing encapsulating peritonitis (SEP) involves presence of a thick, fibrotic, cocoon-like membrane (FIG 1), partially or totally encasing the small bowel. This is a rare but serious condition that presents as recurrent episodes of bowel obstruction, weight loss, nausea and anorexia, and at times a palpable abdominal mass. However, clinically preoperative diagnosis requires a high index of clinical suspicion and knowledge of the radiologic features is necessary. Imaging serves as a very useful tool. The etiology of SEP is multifactorial, with a wide variety of...

Findings and procedure details

Sclerosing encapsulating peritonitis (SEP) is a rare form of peritoneal inflammation which involves both the visceral and the parietal surfaces of the abdominal cavity. SEP is characterized by a fibrous thickening of the peritoneum and is reported to complicate peritoneal dialysis, certain drugs, and infectious peritonitis.It is also called abdominal "cocoon" owing to its appearance. (FIG 1). SEPhas been reported in a wide range of ages, with the youngest patient in our study being a 28 year old boy and the oldest patient being an...

Conclusion

SEP is a benign condition with a variety of proposed causes. This condition is still considered life threatening, because of its high fatality rate. Best outcomes have been reported for patients in whom early surgery has been performed. Thus, early diagnosis is of paramount importance. A high index of suspicion and a familiarity with the multimodality radiologic findings enable early diagnosis, which could markedly affect patient outcome.

Personal information and conflict of interest

Chandni. Wadhwani; Pune, GU/IN - nothing to disclose email id: [email protected] Sonali. Honavar; Pune, GU/IN - nothing to disclose email id: [email protected]

References

1.Owtschinnikow PJ. Peritonitis chronica fibrosa incapsulata. Arch Klin Chir 1907;83:623–634. 2.Foo KT, Ng KC, Rauff A, Foong WC, Sinniah R. Unusual small intestinal obstruction in adolescent girls: the abdominal cocoon. Br J Surg 1978;65(6):427–430. 3.https://radiopaedia.org/articles/encapsulating-peritoneal-sclerosis 4.Yip FW, Lee SH. The abdominal cocoon. Aust N Z J Surg1992;62(8):638–642. 5.Kirshtein B, Mizrahi S, Sinelnikov I, Lantsberg L. Abdominal cocoon as a rare cause of small bowel obstruction in an elderly man: report of a case and review of the literature. Indian J Surg 2011;73(1):73–75.