Sclerosing encapsulating peritonitis in a long-term propranolol user

Area of Science:

• Gastroenterology
• Abdominal Surgery
• Pharmacology

Background:

• Sclerosing encapsulating peritonitis (SEP) is a rare condition causing bowel obstruction, characterized by fibrous encasement of the small bowel.
• The pathophysiology of SEP remains poorly understood, and accurate preoperative diagnosis is challenging.
• Existing literature suggests a potential link between chronic use of beta-adrenergic blockers and SEP development.

Purpose of the Study:

• To report a case of sclerosing encapsulating peritonitis (SEP) in a patient with liver cirrhosis and end-stage renal disease on hemodialysis.
• To investigate the potential association between long-term propranolol use and the development of SEP.
• To describe the diagnostic findings and surgical management of SEP.

Main Methods:

• A 46-year-old male patient with a history of liver cirrhosis and ESRD on hemodialysis presented with symptoms of bowel obstruction.
• Diagnostic imaging included abdominal CT and barium follow-through, followed by exploratory laparotomy.
• The patient had a 15-year history of propranolol use for esophageal varices prophylaxis.

Main Results:

• Abdominal CT revealed small bowel loops encapsulated by soft tissue with proximal dilatation.
• Barium follow-through demonstrated conglomerated distal ileal loops with a cauliflower-like appearance.
• Surgical exploration confirmed a thick, fibrous capsule encasing the ileal loops, which was successfully excised, leading to symptom improvement.

Conclusions:

• The patient was diagnosed with sclerosing encapsulating peritonitis (SEP) post-surgery.
• Given the absence of other identifiable causes, long-term propranolol use is implicated as a potential contributing factor to SEP in this case.
• This case underscores the importance of considering medication history in the diagnosis and management of SEP.