Sclerosing Encapsulating Peritonitis in an Extensively Drug-Resistant Tuberculosis Patient Presenting as Intestinal Obstruction – A Case Report
Abstract
Sclerosing encapsulating peritonitis (SEP), also called abdominal cocoon syndrome, is a rare cause of intestinal obstruction. In 1907, Owtschinnikow first termed it as peritonitis chronica fibrosa encapsulata. It can be either idiopathic or secondary. Secondary cocoon syndrome may be due to medications, infections such as tuberculosis (TB) in endemic regions, cirrhosis, peritoneal dialysis and gynaecological malignancies.
A 37-year-old female diagnosed with abdominal TB, who had not complied with anti-tubercular therapy (ATT) for the last 5 years, presented with acute intestinal obstruction and a history of recurrent subacute intestinal obstruction. Computed tomography (CT) imaging of the abdomen showed dilated bowel loops with a transition point in the ileum, multiple large calcified mesenteric lymph nodes and ascites. Diagnostic laparoscopy revealed dense adhesions and a fibrocollagenous membrane encapsulating the intestine. It was converted to laparotomy, an abdominal cocoon was confirmed, and extensive adhesiolysis and ileocolic anastomosis were done. GeneXpert showed extensively drug-resistant tuberculosis (XDR-TB), and the patient was started on an XDR-TB regimen.
Abdominal cocoon syndrome secondary to TB, presenting as intestinal obstruction, is a rare but serious complication that requires surgical intervention. This case further highlights the importance of adherence to medication and the consideration of resistant forms of TB, such as XDR-TB, in patients with…
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