Intest Res.  2016 Oct;14(4):375-378. 10.5217/ir.2016.14.4.375.

Sclerosing encapsulating peritonitis in a long-term propranolol user

• Noh SH
• Ye BD
• So H
• Kim YS
• Suh DJ
• Yoon SN

• KMID: 2354957
• DOI: http://doi.org/10.5217/ir.2016.14.4.375

Abstract

Sclerosing encapsulating peritonitis (SEP) is a rare cause of bowel obstruction that is characterized by the encasement of the small bowel by a thick, whitish, and fibrous membrane. The pathophysiology of SEP is poorly understood and preoperative diagnosis is difficult. Previous reports suggest that SEP may be linked to the chronic use of β-adrenergic blockers. A 46-year-old man with liver cirrhosis and end-stage renal disease on hemodialysis presented with recurrent abdominal pain and borborygmi. He had been taking propranolol to prevent bleeding from gastroesophageal varices for the past 15 years. Abdominal computed tomography showed ileal loops encapsulated by soft tissue with dilatation of the proximal small bowel on the right side of the abdomen. Barium follow-through showed conglomerated distal ileal loops with a cauliflower-like appearance. Explorative laparotomy revealed a thick, fibrous, whitish capsule encapsulating the ileal loops. The covering membrane was dissected and excised, resulting in an improvement in symptoms after surgery. Accordingly, a final diagnosis of SEP was made. Due to the lack of other apparent causes for SEP, we conclude that in this case, the long-term use of propranolol may be associated with the development of SEP.

Keyword

Abdominal pain; Peritonitis; Propranolol

MeSH Terms

Abdomen
Abdominal Pain
Barium
Diagnosis
Dilatation
Hemorrhage
Humans
Kidney Failure, Chronic
Laparotomy
Liver Cirrhosis
Membranes
Middle Aged
Peritonitis*
Propranolol*
Renal Dialysis
Varicose Veins
Barium
Propranolol

Figure

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  Fig. 1 Plain abdominal radiography. Small bowel dilatation and airfluid levels are seen in the right side of the patient's abdomen (upright position).

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  Fig. 2 Abdominal CT findings. Abdominal CT showing large amounts of ascites and ileal loops encapsulated by soft tissue (arrows) with dilatation of the upstream small bowel on the right side of the abdomen. (A) Transverse section. (B) Coronal section.

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  Fig. 3 Barium follow-through (BFT) finding. BFT showing conglomerated distal ileal loops with a cauliflower-like appearance.

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  Fig. 4 Surgical findings. (A) Explorative laparotomy showing a thick, fibrous, and white capsule encapsulating ileal loops. (B) Dissection and excision of the capsule released a 1.5 m-long loops of ileum from the capsule.

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  Fig. 5 Microscopic findings of the resected capsule. A dense fibrous wall without epithelial lining is seen (A, H&E, ×40; B, H&E, ×100).

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