Sclerosing encapsulating peritonitis in advanced liver cirrhosis presenting with acute small bowel obstruction: a case report and literature review

TL;DR

A rare case of sclerosing encapsulating peritonitis causing bowel obstruction in a cirrhotic patient is reported, highlighting the need for early surgical decisions and awareness of this condition.

Contribution

This case report adds to the limited literature on sclerosing encapsulating peritonitis in advanced liver cirrhosis and emphasizes its clinical significance.

Findings

SEP is an uncommon cause of acute small bowel obstruction in cirrhotic patients.

Surgical intervention is required but carries high perioperative risks in cirrhotic patients.

SEP should be considered in the differential diagnosis for bowel obstruction in cirrhotic patients on long-term beta blockers.

Abstract

Sclerosing encapsulating peritonitis (SEP) is an inflammatory condition characterized by the encasement of the small bowel in a dense fibro-collagenous membrane resulting in acute bowel obstruction. In the context of liver disease, SEP is exceptionally rare, with only eight known cases to date. We describe the case of a 52-year-old male presenting to a rural hospital with acute small bowel obstruction secondary to SEP in the setting of decompensated liver cirrhosis. SEP is an uncommon cause of acute small bowel obstruction. Definitive treatment requires surgical intervention, typically with enterolysis and excision of the abdominal cocoon. For patients with cirrhosis, this is associated with exceptionally high perioperative morbidity and mortality. SEP is an important differential in cirrhotic patients presenting with acute bowel obstruction, particularly in the context of long-term beta blocker use. Early discussions regarding prognosis and careful patient selection for surgical intervention are of paramount importance.

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