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Sclerosing peritonitis presenting as complete mechanical bowel obstruction: a case report
1Department of General surgery, Aga Khan University Hospital, Karachi, Pakistan. Sabah.saqib@aku.edu.
Journal of Medical Case Reports
|October 19, 2019
Summary
Sclerosing peritonitis, a rare cause of bowel obstruction, can be mistaken for tuberculosis. Surgical excision of the membrane and a short steroid course are effective treatments for this condition.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Sclerosing peritonitis, also known as abdominal cocoon syndrome, involves small bowel encapsulation by a fibrocollagenous membrane.
- While often associated with peritoneal dialysis, it can occur spontaneously and rarely presents as complete mechanical bowel obstruction.
Observation:
- A 46-year-old man presented with complete mechanical bowel obstruction, previously misdiagnosed as abdominal tuberculosis due to regional prevalence.
- He experienced recurrent partial bowel obstructions over 6-8 months, unresponsive to anti-tuberculosis therapy.
Findings:
- Diagnostic laparoscopy followed by laparotomy revealed a fibrocollagenous membrane entrapping the small bowel.
- Surgical excision of the membrane and adhesiolysis successfully freed the bowel.
Implications:
- Sclerosing peritonitis is a rare, benign cause of complete mechanical bowel obstruction, often misdiagnosed in tuberculosis-endemic areas.
- Contrast-enhanced CT and diagnostic laparoscopy aid in diagnosis, with surgical intervention and steroid therapy for relapses being the management approach.
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