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Sclerosing Encapsulating Peritonitis in a Pediatric Patient Treated With Cytoreductive Surgery and Hyperthermic
Richard S Whitlock1, Tahir Malik1, Valeria Smith2
1Michael E. DeBakey Department of Surgery, Divisions of Pediatric Surgery and Surgical Research, Texas Children's Hospital Surgical Oncology Program, Dan L. Duncan Cancer Center.
Insights
Sclerosing encapsulating peritonitis (SEP) is a rare condition. This case highlights the first pediatric oncology patient diagnosed with secondary SEP after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
Area of Science:
- Oncology
- Gastroenterology
- Surgical Pathology
Background:
- Sclerosing encapsulating peritonitis (SEP) is a rare chronic inflammatory condition.
- It involves small bowel encapsulation by a thick fibrocollagenous membrane.
- Secondary SEP is associated with peritoneal dialysis and cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC).
Observation:
- A 13-year-old female presented with abdominal pain, distension, and emesis.
- She was diagnosed with SEP 13 months post-CRS and HIPEC for desmoplastic small round cell tumor.
- The patient required operative intervention.
Findings:
- This report details the first documented case of secondary SEP in a pediatric oncology patient.
- The patient's symptoms were consistent with intestinal obstruction.
- Diagnosis was confirmed following surgical intervention.
Implications:
- This case expands the understanding of secondary SEP in pediatric patients post-CRS/HIPEC.
- It underscores the importance of considering SEP in pediatric oncology patients with relevant symptoms.
- Further research may be needed to elucidate the mechanisms and long-term outcomes of SEP in this population.
Background:
Sclerosing encapsulating peritonitis (SEP) is a rare chronic inflammatory condition characterized by small bowel encapsulation by a thick fibrocollagenous membrane. Patients with SEP often present with nonspecific symptoms, such as abdominal pain and distension, however some patients may present with symptoms suggestive of intestinal obstruction. Secondary SEP has been reported in patients undergoing peritoneal dialysis and has been recently described in adults following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
Observations:
We report a clinical case of a 13-year-old female who presented with worsening abdominal pain and distension and persistent emesis who was found to have SEP 13 months following CRS and HIPEC for management of desmoplastic small round cell tumor and subsequently required operative intervention.
Conclusion:
Although there have been published reports of adult patients experiencing cases of SEP following CRS/HIPEC, this is the first published case of secondary SEP occurring in a pediatric oncology patient.
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