A 36-years-old male patient from India was presented to our hospital with abdominal pain mainly in the left upper quadrant in association with nausea and vomiting for 1 day. He denied any history of similar attacks before, no personal history of tuberculosis, 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 with his abdominal examination was soft with left upper quadrant tenderness. His basic blood workups were not significant, as well as his inflammatory marker was not elevated.
Initially, an abdominal X-ray was done for him, which showed non-specific bowel distribution with no air-fluid level. Then, he underwent CT of the abdomen and pelvis with intravenous contrast. It showed a small bowel cluster in the mid-abdomen with a small bowel dilation with a transition zone at the distal ileum, along with a trace amount of stool in the colon. There were no signs of bowel perforation or ischemia. The small bowel was encased by a membrane forming a sac with a small amount of free fluid in it (Figures 1A,B). The finding gives us the impression of sclerosing encapsulating peritonitis.
He underwent exploratory laparotomy with the intraoperative finding of a thick membrane covering the small bowel (Figure 2); 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 was no bowel perforation or gangrene. Also, appendectomy was done for the patient anticipating difficult intraoperative access in case he had appendicitis in the future. 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 the surgery; he was symptom free with his wound healed very well. The pathology report showed a fibrocollagenous membrane with chronic lymphocytic inflation. Mycobacterium culture was negative.