Idiopathic Sclerosing Encapsulating Peritonitis Associated With Persistent Descending Mesocolon: A Surgical Puzzle

Area of Science:

• Gastroenterology and Surgery
• Abdominal Imaging and Diagnostics

Background:

• Exploratory abdominal laparotomies can reveal unexpected findings despite comprehensive preoperative assessments.
• Sclerosing encapsulating peritonitis (SEP) is a rare condition characterized by a fibrocollagenous membrane encasing abdominal organs.
• Persistent descending mesocolon is an uncommon anatomical variation where the colon's mesentery fails to fuse with the posterior abdominal wall.

Observation:

• An 80-year-old male presented with an acute abdomen, posing a diagnostic challenge.
• Preoperative studies did not fully elucidate the cause of the acute abdominal presentation.
• The patient's condition was complicated by the simultaneous presence of two rare conditions.

Findings:

• The surgical exploration revealed sclerosing encapsulating peritonitis (SEP), a rare cause of bowel obstruction.
• The patient also exhibited a persistent descending mesocolon, an unusual anatomical anomaly.
• This is the first reported case to describe the co-occurrence of SEP and persistent descending mesocolon.

Implications:

• This case highlights the importance of considering rare diagnoses in complex abdominal presentations.
• Understanding these rare conditions is crucial for accurate surgical planning and patient management.
• Further research into the pathogenesis and clinical implications of co-occurring rare abdominal conditions is warranted.