Abstract
Introduction: Sclerosing encapsulating peritonitis (SEP) is a rare condition. Underlying cause of SEP is believed to be multifactorial. It can occur secondary to several conditions like prior episodes of severe peritonitis, use of beta-blockers, history of peritoneal dialysis, autoimmune disease, intra-abdominal malignancies, exposure to chemicals such as silicosis or asbestosis, endometriotic cyst, uterine leiomyomas, ovarian tumors, sarcoidosis, or tuberculosis. Case Report: We report an unusual case of a 74-year-old male patient of Dutch descent presented with intermittent watery diarrhea, recurrent ascites and bilateral lower limb lymphedema. Conclusion: Symptoms of the patient at initial presentation were non-specific. Bilateral lower limb lymphedema has not been previously identified in literature as a presenting symptom of this disease. Clinicians need to have a higher index of suspicion for the diagnosis of SEP in those that present with bilateral lower limb lymphedema and non-specific abdominal symptoms. The etiology of SEP in this patient remains unclear, which is consistent with most of the cases reported in literature to date.
Highlights
Sclerosing encapsulating peritonitis (SEP) is a rare condition
It can occur secondary to several conditions like prior episodes of severe peritonitis, use of beta-blockers, history of peritoneal dialysis, autoimmune disease, intra-abdominal malignancies, exposure to chemicals such as silicosis or asbestosis, endometriotic cyst, uterine leiomyomas, ovarian tumors, sarcoidosis, or tuberculosis
Case Report: We report an unusual case of a 74-year-old male patient of Dutch descent presented with intermittent watery diarrhea, recurrent ascites and bilateral lower limb lymphedema
Summary
Sclerosing encapsulating peritonitis (SEP) is a rare condition with varying prevalence around the world. After four weeks on steroid treatment, his edema had reduced significantly and his bowel symptoms improved Despite improved symptomatology, he was revisited by the surgeon in clinic, who continued to be suspicious for intra-abdominal malignancy and insisted on diagnostic laparoscopy being performed. The histology of peritoneal biopsy revealed tissues containing bland spindle cells separated by collagen, some of which is thick and eosinophilic; with rare mitotic figure noted but no atypical figures were identified. Omental tissue biopsies showed thin submesothelial zone of collagenous connective tissue containing cytologically bland spindle cells, similar to those seen in the peritoneal biopsy. These histological features were consistent with sclerosing peritonitis. The patient developed acute bowel obstruction and died from sepsis eight months later
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