A Case of Idiopathic Sclerosing Peritonitis

Hee Jung Ryu; Young Bae Park; Jung Hwa Lee; Hye Seung Lee; Eun Young Lee; Yun Jong Lee; Eun Bong Lee; Yeong Wook Song

doi:10.4078/jkra.2008.15.2.180

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Ryu, Park, Lee, Lee, Lee, Lee, Lee, and Song: A Case of Idiopathic Sclerosing Peritonitis

Original Article

J Korean Rheum Assoc 2008;15(2):180-185.

Published online: 20 June 2008

DOI: https://doi.org/10.4078/jkra.2008.15.2.180

A Case of Idiopathic Sclerosing Peritonitis

Hee Jung Ryu, Young Bae Park, Jung Hwa Lee, Hye Seung Lee^∗, Eun Young Lee, Yun Jong Lee, Eun Bong Lee, Yeong Wook Song

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

^∗Department of Pathology, Seoul National University Bundang Hospital∗, Seongnam, Korea

Received 6 May 2008 Accepted 27 May 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Idiopathic sclerosing peritonitis is a rare disease characterized by fibrosis and adhesion of the peritoneum to loops of the small intestine. It may be the cause of an unusual surgical emergency such as small bowel ileus. It is diagnosed predominantly in female adolescents. We report the case of an idiopathic sclerosing peritonitis in Korea. A 38-year-old man visited emergency room for recurrent small bowel ileus and migrating mass like lesion. Computed tomography (CT) of abdomen showed acute peritonitis with a diffuse wall thickening of terminal ileum and extraluminal fluid collectionaround the terminal ileum. He underwent laparotomy. The ileocolectomy with adhesiolysis was performed and its pathological examination revealed the characteristic findings of idiopathic sclerosing peritonitis. Symptoms recurred 2 months after surgery, but improved with steroid treatment.

Keywords: Fibrosis, Idiopathic, Sclerosing peritonitis

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Fig. 1.

Simple abdomen erect and supine views show severe small bowel dilatation, suggesting small bowel obstruction.

Fig. 2.

Abdominal CT. The terminal ileum shows diffuse wall thickening. It reveals the lower abdominal peritonitis and extraluminal fluid collection around the terminal ileum.

Fig. 3.

Ileocolectomy. The terminal ileum reveals adhesion with colon and polypoid elevation of serosa with severe fibrosis (arrow).

Fig. 4.

Histopathology of ileum and ascending colon. The mucosa of colon shows no crypt changes and ulcerations (A). The serosa of ileum and ascending colon shows severe fibrosis, fibrinoid necrosis and fibroblast hyperproliferations (B∼D).

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