A 38-year-old man seen for abdominal distension, abdominal pain, and vomiting was found in abdominal US and CT to have a pool of marked ascites and the whole bowel lumped together. These findings suggested strangulation or volvulus of the small intestine. A large amount of serous ascites was seen in the abdominal cavity. The peritoneum was covered by a thick white membrane and the bowel could not be distinguished. Bowel mobility was not visible during surgery. A hard white membrane covered the surface of the entire peritoneum including the cirrhotic liver. The operation finished with abdominal lavage with saline. Operative findings suggested diagnosis of sclerosing encapsulating peritonitis (SEP). Steroid pulse therapy enabled the man to eat on discharge, but he returned that day due to abdominal pain, diagnosed as perforation of the duodenal bulb. Although we closed the perforated site, we recognized anastomotic failure. He died of sepsis and hepatic failure. SEP is a rare disease characterized macroscopically by a "cocoon-like appearance", but sometimes reported as a complication of CAPD. To our knowledge, this is scarce report of SEP complicated by liver cirrhosis, which we thought was spontaneous bacterial peritonitis (SBP) complicated by liver cirrhosis. Repeated intra peritoneal chronic infection appeared related to SEP.
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