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Sclerosing encapsulating peritonitis in a long-term propranolol user.

Se Hui Noh1, Byong Duk Ye2, Hoonsub So1

  • 1Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Intestinal Research
|November 2, 2016
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Summary

Sclerosing encapsulating peritonitis (SEP), a rare cause of bowel obstruction, may be linked to long-term propranolol use. This case report highlights a potential association between beta-blocker therapy and SEP development.

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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.