Primary Sclerosing Encapsulating Peritonitis and Meckel’s Diverticulum in a Patient with Small Bowel Obstruction: A Rare Entity

Abstract

Background: Sclerosing Encapsulating Peritonitis (SEP) is a rare cause of small bowel obstruction. There are other similar and rare entities like peritoneal encapsulation found in different age groups. Management in severe cases is mostly surgical. Laparoscopic approach may be useful for diagnosis but difficult to proceed with. It is important to differentiate between idiopathic (primary) SEP and secondary SEP as management may differ, especially in a Tubercular Abdomen. Case Summary: We describe a case of Primary SEP in a 45-year-old male presenting as small bowel obstruction (SBO). Due to failure of conservative management patient underwent exploratory laparotomy, excision of the membrane, adhesiolysis, appendectomy and resection of Meckel’s Diverticulum. On-table appearance fitted the picture of primary SEP, and no evidence of tubercular pathology was noted. The surgical treatment led to resolution of bowel obstruction, although this was complicated with a minor leak which was managed conservatively. Conclusion: Primary SEP is a rare cause of small bowel obstruction. This entity is often confused with tubercular abdomen in tropics which may lead to delay in surgical treatment and should be differentiated from Secondary SEP which is more frequently encountered in patients with  peritoneal  irritation from various aetiologies. Nevertheless, preoperative diagnosis is difficult, and a high degree of suspicion is required for diagnosis.