A 26-year-old patient from India, not known to have any chronic medical illness, presented to our ER department complaining about generalized abdominal pain for 5 days associated with nausea and vomiting for 1 day. He had a similar episode 5 months ago, which got resolved spontaneously. He denied any personal history of Tb or contact with any Tb patient. Also, he had no history of previous abdominal surgeries. Upon examination, the patient's vital signs were found stable, and his abdominal examination was distended with left- and right-upper quadrant mild tenderness without any sign of peritonitis, and digital rectal examination revealed an empty rectum with no mass. His basic blood workups showed high WBC, reaching 18.8 (k/ul), as well as his inflammatory marker was elevated.
Initially, an abdominal X-ray was done for him, which showed non-specific bowel distribution with no air-fluid level. Then, he underwent a CT of the abdomen and pelvis with intravenous contrast. It showed multiple dilated fluid-filled small bowel loops in the center of the abdominal cavity with thin, soft tissue non-enhancing capsule encasing the small bowel loops with mesenteric congestion involving small and large bowel loops with a small amount of free fluid in it (Figure 3). The finding gives us the impression of sclerosing encapsulating peritonitis.
He underwent exploratory laparotomy with the intraoperative finding of thick membrane covering the small bowel (Figure 4); adhesiolysis was done and the sac was excised from the small bowel to the root of the mesentery. The sac was sent for pathology review and mycobacterium culture. There were no bowel perforation or gangrene. His postoperative course was smooth without complication, diet advanced as tolerated, and he was discharged on postoperative day 5.
He was last seen in the clinic 3 months after surgery; he was symptom free with his wound healed very well. The pathology report showed a thick fibrocollagenous membrane with chronic lymphohistocytic infiltrate. Mycobacterium culture was negative.