Peritoneal sarcoidosis mimicking peritoneal carcinomatosis

Describtion of a rare case of intestinal obstruction due to peritoneal sarcoidosis mimicking peritoneal carcinomatosis, and of the literature review about its surgical management.

A 69 year-old woman was referred to our emergency department with diffuse abdominal pain, enteric vomiting and constipation. Abdominal CT showed a dilatated small bowel loops extended to the jejunum with a mechanical obstruction. Given the failure of a non operative management, an explorative laparotomy was performed.

Intraoperative evaluation showed an omental cake with extensive adhesions between small bowel and abdominal wall. The adhesion band determining occlusion was identified and cut. Furthermore, several peritoneal and omental biopsies were performed. Postoperative period was uneventful. Unfortunately, one month later, the patient died following an episode of spontaneous pneumothorax and respiratory complications.

Sarcoidosis is a chronic multisystemic disorder of unknown aetiology with granulomatous inflammation. Peritoneal involvement is a rare presentation of sarcoidosis. Clinical presentation depends on the extent of organ involvement. In some cases,symptoms are no specific and uncommon findings have been reported so far.

Despite a peritoneal carcinomatosis was suspeted, this case shows that abdominal sarcoidosis might be considered as a differential diagnosis when a lesion suspected of being peritoneal carcinomatosis shows non-typical clinical presentations.

Peritoneal sarcoidosis, Small bowel obstruction.