Sclerosing encapsulating peritonitis as a rare cause of intestinal obstruction after the treatment of peritoneal mesothelioma: a case report and review of the literature

Our plain-English summary of Sclerosing encapsulating peritonitis as a rare cause of intestinal obstruction after the treatment of peritoneal mesothelioma: a case report and review of the literature, by Z. Ni, Q. Chen, C. Huang, et al (Translational Cancer Research, 2021).

The study

• Authors: Z. Ni, Q. Chen, C. Huang, S. Wang, Q. Huang
• Journal: Translational Cancer Research
• Published: 2021;10(6):3074-3080
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction that is characterized by a thick greyish-white fibrotic membrane encasing the small bowel. The clinical features are typically nonspecific, and they occasionally present with recurrent episodes of incomplete or complete intestinal obstruction. The etiology of SEP remains unclear, and the diagnosis is often delayed mainly due to the lack of specific symptoms. Here, we first report a patient who suffered from SEP after treatment for malignant mesothelioma (MM) with tumor resection supplemented with hyperthermic intraperitoneal chemotherapy (HIPEC) once and intraperitoneal chemotherapy (IPC) eight times. The patient was discharged ten days after surgery and was free of complications at the 4-month follow-up. In addition, we reviewed the published literature from PubMed, only 7 articles of 16 cases finally met the defined requirements. Nine cases of SEP after IPC and 7 cases of SEP after HIPEC were previously reported. We synthetically review the pathogenesis, treatments, and outcomes. In conclusion, SEP is a rare abdominal disease, which is difficult to diagnose preoperatively. CT scanning is the most helpful imaging method for the diagnosis of SEP. Surgery is the most effective method for diagnosis and treatment, if conservative treatment has no effect or abdominal symptoms are aggravated.

2021 Translational Cancer Research. All rights reserved.

In plain English

This article was a case report combined with a review of earlier published case reports. The authors described a 32-year-old woman who came to hospital in January 2019 with signs of small bowel obstruction. At age 28 her malignant mesothelioma had been removed. Afterwards she received heated chemotherapy inside the abdomen (HIPEC) with cisplatin once, and eight rounds of cisplatin given into the abdomen (IPC) plus intravenous pemetrexed. CT scans and surgery showed her small intestine encased in thick fibrous membranes, a condition called sclerosing encapsulating peritonitis (SEP). Surgeons freed the bowel. The removed tissue showed fibrous tissue along with peritoneal mesothelioma. She had no complications at the 4-month follow-up. A PubMed search found 7 articles describing 16 earlier surgically treated cases of SEP: 9 after IPC and 7 after HIPEC. The authors concluded that SEP is rare and hard to diagnose before surgery, that CT is the most helpful imaging method, and that surgery is the last option when conservative treatment fails. The article did not discuss asbestos.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report of one patient, with a literature review of previously published case reports (PubMed, up to December 2019, English-language case reports only)
• Who was studied: One 32-year-old woman with a history of malignant mesothelioma, seen in January 2019 with acute small bowel obstruction. The review covered 16 previously reported cases from 7 articles.
• Exposure: No asbestos exposure was reported. The exposure considered was treatment for malignant mesothelioma: tumor resection at age 28, then HIPEC with cisplatin 600 mg once, and IPC with cisplatin 50 mg plus intravenous pemetrexed 800 mg eight times.
• Main results:
  • Since the mesothelioma resection, the patient had had several episodes of incomplete bowel obstruction that were relieved by conservative treatment.
  • Abdominal CT showed clumped small intestine loops enclosed within a membranous cavity.
  • At surgery, the bowel from the proximal jejunum to the distal ileum was completely encased by thickened fibrous membranes. SEP was confirmed and the adhesions were released.
  • Microscopic examination of the resected membrane showed high proliferation of fibroconnective tissue associated with peritoneal mesothelioma.
  • Bowel movements returned on day 9 after surgery. The patient had no complications and normal bowel function at the 4-month follow-up.
  • The literature search found 2,790 papers, of which 465 were case reports. Seven articles describing 16 cases of SEP after IPC or HIPEC treated surgically met the criteria: 9 cases after IPC and 7 after HIPEC.
• The authors' conclusion: The authors concluded that SEP is rare and difficult to diagnose before surgery, that it should be considered in patients with intestinal obstruction after HIPEC or IP chemotherapy, that CT scanning is the most helpful imaging method, and that surgery is the last option if conservative treatment fails or symptoms worsen.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Etiology, Mesothelioma, HIPEC, Chemotherapy.

Related studies

• Diffuse malignant peritoneal mesothelioma presenting as intestinal obstruction — J. Griniatsos, S. Sougioultzis, et al. (2009)
• Benign Multicystic Peritoneal Mesothelioma (BMPM) as a rare cause of abdominal pain in a young male: case report and review of the literature — S. Gussago, P. Spina, et al. (2019)
• Benign Multicystic Peritoneal Mesothelioma (BMPM) as a rare cause of abdominal pain: a case report and review of the literature — H.B. Hassine, M. Touati, et al. (2025)
• Asbestos fibre dust and gastro-intestinal malignancies. Review of literature with regard to a cause/effect relationship — A.B. Miller (1978)
• Primary Peritoneal Mesothelioma Resulting in Small Bowel Obstruction: A Case Report and Review of Literature — S.C. Frontario, A. Loveitt, et al. (2015)
• Malignant peritoneal mesothelioma as a rare cause of ascites: a case report — I. Ahmed, A. Koulaouzidis, et al. (2008)

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