Primary Sclerosing Encapsulating Peritonitis

Dr. Swati Sahay_

Background: Sclerosing encapsulating peritonitis also known as cocoon abdomen is a rare chronic inflammatory condition of the peritoneum in which the bowel loops are encircled by a membrane (cocoon formation) within the peritoneal cavity leading to intestinal obstruction. It can be primary (idiopathic) or secondary (chemotherapy, beta blockers, peritoneal dialysis, shunts, tuberculosis, SLE etc.). Symptomatology reported includes recurrent episodes of abdominal pain, distension or mass.

Case Report: 30 yrs old male presented with complains episodes of vomiting and bloating since two weeks. USG findings revealed acute small bowel obstruction due to cocoon formation with suspicion of pneumatosis. CT report showed high grade small bowel obstruction and pneumatosis in trapped ileal loops along with pelvic free fluid and fascial thickening. No significant history of drug and any chronic illness. The patient underwent surgery and resected bowel specimen was received for histopathological examination.
Microscopic examination showed infiltration of lamina propria by dense inflammatory infiltrates and fatty infiltration along with dilated and congested blood vessels, lymphatics and mixed inflammatory infiltrate in the submucosa.
The serosa showed mesenchymal proliferation.

Conclusion: This case is considered worth for presentation due to its rarity and lack of identification
of secondary factors despite extensive investigation.

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