An incidental intra-operative finding of sclerosing encapsulating peritonitis, “abdominal cocoon” in an emergency presentation of small bowel obstruction, a case report

INTRODUCTION AND IMPORTANCE: Sclerosing encapsulating peritonitis (SEP) is a disease characterized by a chronic inflammatory process in which the small intestines are encased by a dense fibrocollagenous membrane. In this article, we report a 57 year old male who presented with bowel obstruction secondary to sclerosing encapsulating peritonitis with an initial imaging suggesting internal hernia. CASE PRESENTATION: A 57-year-old male, who presented to the emergency department at our center with a chronic persistent nausea and vomiting, associated with anorexia, constipation and weight loss, CT scan showed a transition zone seen at the duodeno-jejunal (DJ) junction and findings suggesting internal hernia, he was treated conservatively initially followed by a diagnostic laparoscopy that was converted to open with intraoperative findings of intra-abdominal cocoon rather than an internal hernia, managed with adhesolysis and discharged home in stable good condition. CLINICAL DISCUSSION: There are multiple factors that could attribute to PSEP including cytokines, fibroblasts, and angiogenic factors, such patients might be asymptomatic or presenting with GI obstruction symptoms. The diagnosis of PSEP varying from abdominal x rays to contrast enhanced CT scan. CONCLUSION: The management of PSEP depends on the presentation and should be individualized, weather conservative medical or surgical approach can be used.