Sclerosing Encapsulating Peritonitis: A Diagnostic Dilemma

t m n w a m 39-year-old man presented with a 6-year history of ecurrent episodes of nonfebrile, diffuse, crampy, abominal pain, nausea, and bloating, with normal bowel ovement. These episodes occurred 1 to 2 times per ear, lasting 36 hours, and resolved spontaneously. In the revious 6 months he noted an increase in frequency and everity of recurrences along with a weight loss of 6 kg 10% of body weight). He had an unremarkable past edical history without any abdominal surgery or liver isease, and he wasn’t taking any medication. On examnation, the abdomen was flat with mild nonspecific iffuse tenderness. There was no palpable mass. Bowel ounds were weak. Routine blood analysis was normal. pper gastrointestinal endoscopy and colonoscopy with erminal ileoscopy were normal. Contrast-enhanced CT of the abdomen showed a hickening of the last 20 cm of the distal jejunum surounded by a moderate dilatation of the proximal jejuum and by a conglomeration of ileal loops (A). The last 0 cm of the ileum were normal, as was the colon. A mall-bowel followthrough revealed a bowel wall thickning of a distal jejunal loop without mucosal abnormalties followed by a “cauliflower-like” disposition of the leum loops situated 10 cm above the ileocecal valve (B, rrowheads). An abdominal MRI confirmed the images f the CT scan. f