Sclerosing Encapsulating Peritonitis, (SEP) is characterised by a thick fibro-collagenous membrane encapsulating the small bowel to various degrees. SEP could be either idiopathic/primary or secondary to peritoneal irritation from various aetiologies especially tubercular abdomen in tropics. This case highlights presentation, workup and management and complications associated with PSEP. A 45-year-old gentleman of Indian origin presented with symptoms of bowel obstruction on background of chronic abdominal pain for 9 years, with no risk factors for peritoneal inflammation, and no abdominal surgeries in the past. Contrast enhanced CT revealed dilated small bowel loops covered by a membrane of variable thickness, no ascites, or no signs of tuberculosis and malignancy.

Patient failed initial conservative management & underwent exploratory laparotomy. On laparotomy, the entire small intestine was found to be cocooned and enclosed in a thick fibrotic membrane with clumping of small bowel instigating obstruction. Thick membrane was excised, revealing tortuous, dilated, non-inflamed small bowel and membrane with some further flimsy overlying membranes, no significant inter bowel adhesions and an incidental Meckel’s diverticulum.

Extensive excision of the membrane, appendectomy and resection of Meckel’s diverticulum was done. The surgical treatment led to resolution of bowel obstruction, although this was complicated with a minor small bowel leak which was managed conservatively the histopathology of membrane showed non-specific dense fibrosis, focal areas of calcification and congestion and no granulomas. Abdominal washings were negative for tuberculosis. Based on these findings, confirmed diagnosis of primary sclerosing encapsulating peritonitis as a cause of small bowel obstruction was made. PSEP in TB endemic regions is often misdiagnosed as abdominal TB and unnecessary treated with antitubercular treatment. Aim is to raise the awareness about this entity and distinguish from abdominal tuberculosis especially in endemic areas.

Keywords: Sclerosing Encapsulating Peritonitis, Small bowel obstruction, Abdominal Tuberculosis

Abbreviations: SEP: Sclerosing Encapsulating Peritonitis, PSEP: Primary Sclerosing Encapsulating Peritonitis, TB: Tuberculosis