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Sclerosing encapsulating peritonitis: differential diagnosis to peritoneal encapsulation and abdominal cocoon--a case
G H Wirnsberger1, K Ganser, W Domej
1Department of Medicine, Karl Franzens University, Graz, Austria.
Abstract:
A 59 year old man presented with symptoms of partial bowel obstruction. Small bowel x-ray studies did not allow to identify the nature of the intestinal process in the upper ileum. At laparotomy small bowel encapsulation with a whitish membrane was encountered. Despite partial removal of this membrane small bowel obstruction persisted and two weeks postoperatively the patient died of peritonitis and cardiac insufficiency. Autopsy findings revealed massive fibrous adhesions in the abdomen with granulomatous inflammation. The presence of foreign body giant cells and bifringent crystals were characteristic for talcum powder. The latter suggested a causal role of an appendectomy 45 years earlier. The diagnosis of sclerosing encapsulating peritonitis as established in our patient needs to be separated from peritoneal encapsulation, a congenital malformation, and abdominal cocoon, which contains histological elements of inflammation. This case report should draw attention to these entities in the differential diagnosis and surgical management of small bowel obstruction.
Insights
Talcum powder from a childhood appendectomy caused a rare condition leading to fatal bowel obstruction. This case highlights sclerosing encapsulating peritonitis in small bowel obstruction diagnosis.
Area of Science:
- Gastroenterology
- Pathology
- Surgical Oncology
Background:
- Partial small bowel obstruction can be challenging to diagnose.
- Encapsulating peritoneal thickening requires differentiation from other conditions.
Observation:
- A 59-year-old man presented with partial small bowel obstruction.
- Imaging was inconclusive; laparotomy revealed small bowel encapsulation by a whitish membrane.
- Postoperative obstruction persisted, leading to death from peritonitis and cardiac insufficiency.
Findings:
- Autopsy revealed massive fibrous adhesions with granulomatous inflammation.
- Foreign body giant cells and birefringent crystals indicated talcum powder.
- Talcum powder exposure was linked to an appendectomy 45 years prior.
Implications:
- The patient was diagnosed with sclerosing encapsulating peritonitis.
- This condition must be differentiated from peritoneal encapsulation and abdominal cocoon.
- This case underscores the importance of considering talc-induced peritonitis in small bowel obstruction differential diagnosis.