|
1
|
van Boven E, Coebergh van den Braak RRJ, van Laar J, Betjes MGH. Unexpected finding of encapsulating peritoneal sclerosis: mind the cocoon. BMJ Case Rep 2025; 18:e264334. [PMID: 39870474 DOI: 10.1136/bcr-2024-264334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2025] Open
Abstract
Here, we present a fatal case of a man in his 40s with encapsulating peritoneal sclerosis (EPS). In retrospect, a spot diagnosis on the abdominal CT scan. The patient presented with progressive abdominal complaints of pain and vomiting over the last 2 months. He had a history of therapy-refractory sarcoidosis. A CT scan was performed, and loculated ascites was noted. The patient was admitted with suspected spontaneous peritoneal peritonitis but did not improve on antibiotics. Data from the microbiology, pathology and radiology investigations lead to no diagnosis. Eventually, laparoscopy revealed the diagnosis of EPS. Treatment with tamoxifen to counteract fibrosis and a pulse dose of methylprednisolone was started. Unfortunately, the patient developed a bowel perforation and died. In retrospect, the radiological sign of a cocoon encasing the small bowels should have been a clue to an early diagnosis.
Collapse
Affiliation(s)
- Eva van Boven
- Erasmus MC Universitair Medisch Centrum Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | | | - Jan van Laar
- Clinical Immunology, Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | |
Collapse
|
|
2
|
Bright B, Salam R, Moorthy S. A Case Series and Brief Review of Literature on Encapsulating Peritoneal Sclerosis: Unveiling the Cocoon. Cureus 2024; 16:e73802. [PMID: 39687804 PMCID: PMC11648041 DOI: 10.7759/cureus.73802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Accepted: 11/15/2024] [Indexed: 12/18/2024] Open
Abstract
This case series explores four distinct instances of encapsulating peritoneal sclerosis (EPS), a rare but serious condition characterized by the encapsulation of abdominal viscera, commonly referred to as abdominal cocoon. EPS is associated with severe complications, including bowel obstruction and sepsis, which can significantly impact patient outcomes. The first case involves a 41-year-old male patient who had undergone a liver transplant and ultimately succumbed to extensively drug-resistant (XDR) sepsis. The second case features a 31-year-old male patient diagnosed with abdominal tuberculosis, who successfully recovered following comprehensive antitubercular therapy (ATT). The third case presents a 26-day-old neonate with CHARGE syndrome (coloboma of the eye, heart defects, atresia of the choanae, retardation of growth and development, genital abnormalities, and ear anomalies, including deafness), who tragically succumbed to septic shock. The last case is of a 41-year-old male patient with disseminated tuberculosis who showed marked improvement with appropriate treatment. These cases illustrate the diverse clinical backgrounds and grave outcomes associated with EPS, highlighting the urgent need for early diagnosis and intervention. Despite EPS being a leading cause of small bowel obstruction in many inpatient settings, its diagnosis is frequently overlooked due to insufficient awareness among healthcare professionals. This series aims to enhance understanding of the causes, imaging characteristics, and management strategies for EPS. By disseminating this knowledge, we hope to facilitate earlier identification of the condition, particularly through primary imaging techniques such as ultrasound (USG). Ultimately, increasing awareness and understanding of EPS is crucial to improving patient outcomes and reducing the associated morbidity and mortality.
Collapse
Affiliation(s)
- Bribin Bright
- Radiodiagnosis, Amrita Institute of Medical Sciences, Kochi, IND
| | - Roshna Salam
- Radiodiagnosis, Amrita Institute of Medical Sciences, Kochi, IND
| | - Srikanth Moorthy
- Radiodiagnosis, Amrita Institute of Medical Sciences, Kochi, IND
| |
Collapse
|
|
3
|
Harada W, Banshodani M, Shimamoto F, Shintaku S, Moriishi M, Masaki T, Kawanishi H. Encapsulating Peritoneal Sclerosis 43 Years after Distal Gastrectomy for Early Gastric Cancer. Intern Med 2024; 63:659-663. [PMID: 37468244 PMCID: PMC10982008 DOI: 10.2169/internalmedicine.2037-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/11/2023] [Indexed: 07/21/2023] Open
Abstract
We herein report a case of encapsulating peritoneal sclerosis (EPS) in a patient without chronic kidney disease after gastrectomy. A 69-year-old man underwent distal gastrectomy for early gastric cancer at 25 years old. After 43 years, he developed bowel obstruction and underwent enterolysis of the encapsulated small intestine. A pathological examination of the capsular membranes revealed inflammation, foam, and giant cells that destroyed foreign substances. The patient was discharged 1.5 months later. Foreign body reactions to surgical instruments used in gastrectomy are considered a cause of EPS. EPS due to foreign body reactions to surgical instruments should also be considered in such cases.
Collapse
Affiliation(s)
- Wataru Harada
- Department of Kidney Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Japan
- Department of Nephrology, Hiroshima University Hospital, Japan
| | - Masataka Banshodani
- Department of Kidney Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Japan
| | - Fumio Shimamoto
- Diagnostic Pathology, Pathology Clinic, Japan
- Department of Nursing, Faculty of Health Sciences Dean, Hiroshima Cosmopolitan University, Japan
| | - Sadanori Shintaku
- Department of Kidney Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Japan
| | - Misaki Moriishi
- Department of Kidney Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, Japan
| | - Hideki Kawanishi
- Department of Kidney Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Japan
| |
Collapse
|
|
4
|
Tambuzzi S, Gentile G, Boracchi M, Zoja R, Gentilomo A. A forensic case of abdominal cocoon syndrome. Forensic Sci Med Pathol 2022:10.1007/s12024-022-00562-6. [PMID: 36459388 DOI: 10.1007/s12024-022-00562-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 12/04/2022]
Abstract
The term "cocoon syndrome" defines a sclerosing encapsulating peritonitis (SEP) that involves a chronic fibrotic inflammatory reaction of the parietal peritoneum and of the viscera leading to a complete sclerosis. The cocoon that is formed causes an incarceration of the intestinal loops with severe complications leading to high mortality. We are presenting the case of a 15-year-old young man that underwent surgery for appendectomy and that was evaluated for having a regular abdominal state. During the post-surgery period, however, several episodes of intestinal occlusion required further surgical interventions leading to a right hemicolectomy. The presence of a fibrotic-adhesive ligneous peritonitis with blended intestinal loops, severely thickened walls, and intestinal scaring stenosis was observed during his second surgical operation. A stenosis of the colostomy led to a worsening of the vital signs of the young man with the onset of a cardiac failure and subsequent decease. Macroscopic autopsy examination and histological analysis confirmed the severe obstructive adhesive encapsulating abdominal context allowing to trace back the cause of death to a cocoon syndrome. Since no predisposing factor could be found, we hypothesized that this case could be characterized by an excessive peritoneal reactivity due to surgical appendectomy. Cocoon syndrome is a rare pathology, and its microscopic features are seldomly observed and could be underestimated. We present a directly observed case with a very substantial macroscopic and microscopic context.
Collapse
Affiliation(s)
- Stefano Tambuzzi
- Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute , Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133, Milan, Italy
| | - Guendalina Gentile
- Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute , Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133, Milan, Italy.
| | - Michele Boracchi
- Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute , Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133, Milan, Italy
| | - Riccardo Zoja
- Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute , Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133, Milan, Italy
| | - Andrea Gentilomo
- Dipartimento di Scienza Giuridiche "Cesare Beccaria", Università degli Studi di Milano, Via festa del Perdono, 7, 20122, Milan, Italy
| |
Collapse
|
|
5
|
Peritoneal Sarcoidosis Mimicking Peritoneal Tuberculosis and Advanced Ovarian Carcinoma. Case Rep Obstet Gynecol 2020; 2020:1905649. [PMID: 32695535 PMCID: PMC7361883 DOI: 10.1155/2020/1905649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/05/2020] [Accepted: 06/18/2020] [Indexed: 11/18/2022] Open
Abstract
Sarcoidosis is an inflammatory disease that affects one or multiple organs, most commonly the lungs and lymph nodes. This disease can present in a variety of ways which often makes diagnosis difficult. A 54-year-old postmenopausal African American female with a history of omental carcinomatosis of unknown origin was referred to the gynecology-oncology service at a local community hospital following a laparoscopic incarcerated hernia repair where multiple abdominal lesions suspicious of ovarian carcinomatosis were visualized. She was brought to the operating room for a diagnostic laparoscopy at which point the intra-abdominal survey revealed white tubercle-like lesions that were consistent with peritoneal tuberculosis. The lesions were excised and sent to pathology. The omentum biopsy was originally reported as adipose tissue showing focal fibrosis, focal mild acute inflammation, few cyst formation, and multiple granulomatous chronic inflammation, with multinucleated giant cells. Periodic acid-Schiff stain and acid fast bacilli stain were negative, and a diagnosis of peritoneal tuberculosis was made. The patient was started on an antituberculosis treatment regimen; however, she was not improving. The pathology slides were reexamined and revealed nonnecrotizing granulomatous inflammation consistent with sarcoidosis. The patient was immediately referred to the department of pulmonology and rheumatology, at which point she was started on corticosteroids and had an improvement in her condition.
Collapse
|
|
6
|
Kawaguchi Y, Kawanishi H, Mujais S, Topley N, Oreopoulos DG. Encapsulating Peritoneal Sclerosis: Definition, Etiology, Diagnosis, and Treatment. Perit Dial Int 2020. [DOI: 10.1177/089686080002004s04] [Citation(s) in RCA: 271] [Impact Index Per Article: 54.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Yoshindo Kawaguchi
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Hideki Kawanishi
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Salim Mujais
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Nicholas Topley
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Dimitrios G. Oreopoulos
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| |
Collapse
|
|
7
|
Dave A, McMahon J, Zahid A. Congenital peritoneal encapsulation: A review and novel classification system. World J Gastroenterol 2019; 25:2294-2307. [PMID: 31148901 PMCID: PMC6529893 DOI: 10.3748/wjg.v25.i19.2294] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/23/2019] [Accepted: 03/30/2019] [Indexed: 02/06/2023] Open
Abstract
Congenital peritoneal encapsulation (CPE) is a very rare, congenital condition characterised by the presence of an accessory peritoneal membrane which encases a variable extent of the small bowel. It is unclear how CPE develops, however it is currently understood to be a result of an aberrant adhesion in the peritoneal lining of the physiological hernia in foetal mid-gut development. The condition was first described in 1868, and subsequently there have been only 45 case reports of the phenomenon. No formal, systematised review of CPE has yet been performed, meaning the condition remains poorly understood, underdiagnosed and mismanaged. Diagnosis of CPE remains clinical with important adjuncts provided by imaging and diagnostic laparoscopy. Two thirds of patients present with abdominal pain, likely secondary to sub-acute bowel obstruction. A fixed, asymmetrical distension of the abdomen and differential consistency on abdominal palpation are more specific clinical features present in approximately 10% of cases. CPE is virtually undetectable on plain imaging, and is only detected on 40% of patients with computed tomography scan. Most patients will undergo diagnostic laparotomy to confirm the diagnosis. Management of CPE includes both medical management of the critically-unstable patient and surgical laparotomy, partial peritonectomy and adhesiolysis. Prognosis following prompt surgical treatment is excellent, with a majority of patients being symptom free at follow up. This review summarises the current literature on the aetiology, diagnosis and treatment of this rare disease. We also introduce a novel classification system for encapsulating bowel diseases, which may distinguish CPE from the commoner, more morbid conditions of abdominal cocoon and encapsulating peritoneal sclerosis.
Collapse
Affiliation(s)
- Aneesh Dave
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown 2050, New South Wales, Australia
- Sydney Medical School, Edward Ford Building, the University of Sydney, Camperdown 2006, New South Wales, Australia
| | - James McMahon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown 2050, New South Wales, Australia
| | - Assad Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown 2050, New South Wales, Australia
- Sydney Medical School, Edward Ford Building, the University of Sydney, Camperdown 2006, New South Wales, Australia
| |
Collapse
|
|
8
|
Singhal M, Krishna S, Lal A, Narayanasamy S, Bal A, Yadav TD, Kochhar R, Sinha SK, Khandelwal N, Sheikh AM. Encapsulating Peritoneal Sclerosis: The Abdominal Cocoon. Radiographics 2018; 39:62-77. [PMID: 30526331 DOI: 10.1148/rg.2019180108] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare but serious condition that results in (a) encapsulation of bowel within a thickened fibrocollagenous peritoneal membrane and (b) recurrent episodes of bowel obstruction. Although described by various names in the literature, the preferred term is encapsulating peritoneal sclerosis because it best describes the morphologic and histologic changes in this disorder. The etiology of EPS is multifactorial, with a wide variety of implicated predisposing factors that disrupt the normal physiologic function of the peritoneal membrane-prime among these factors being long-term peritoneal dialysis and bacterial peritoneal infections, especially tuberculosis. The clinical features of EPS are usually nonspecific, and knowledge of the radiologic features is necessary to make a specific diagnosis. The findings on radiographs are usually normal. Images from small-bowel follow-through studies show the bowel loops conglomerated in a concertina-like fashion with a serpentine arrangement in a fixed U-shaped configuration. US demonstrates a "cauliflower" appearance of bowel with a narrow base, as well as a "trilaminar" appearance depicted especially with use of high-resolution US probes. CT is the imaging modality of choice and allows identification of the thickened contrast material-enhanced abnormal peritoneal membrane and the encapsulated clumped bowel loops. In addition, CT can potentially help identify the cause of EPS (omental granuloma in tuberculosis), as well as the complications of EPS (bowel obstruction). Conservative medical treatment and surgical therapy early in the course of EPS have been used for management of the condition. The purpose of this article is to review the nomenclature and etiopathogenesis of EPS, describe the multimodality imaging appearances of EPS, including differentiating its features from those of other conditions mimicking EPS, and give an overview of management options. Online DICOM image stacks are available for this article. ©RSNA, 2018.
Collapse
Affiliation(s)
- Manphool Singhal
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| | - Satheesh Krishna
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| | - Anupam Lal
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| | - Sabarish Narayanasamy
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| | - Amanjit Bal
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| | - Thakur D Yadav
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| | - Rakesh Kochhar
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| | - Saroj K Sinha
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| | - Niranjan Khandelwal
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| | - Adnan M Sheikh
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| |
Collapse
|
|
9
|
Danford CJ, Lin SC, Smith MP, Wolf JL. Encapsulating peritoneal sclerosis. World J Gastroenterol 2018; 24:3101-3111. [PMID: 30065556 PMCID: PMC6064970 DOI: 10.3748/wjg.v24.i28.3101] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/07/2018] [Accepted: 06/25/2018] [Indexed: 02/06/2023] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a debilitating condition characterized by a fibrocollagenous membrane encasing the small intestine, resulting in recurrent small bowel obstructions. EPS is most commonly associated with long-term peritoneal dialysis, though medications, peritoneal infection, and systemic inflammatory disorders have been implicated. Many cases remain idiopathic. Diagnosis is often delayed given the rarity of the disorder combined with non-specific symptoms and laboratory findings. Although cross-sectional imaging with computed tomography of the abdomen can be suggestive of the disorder, many patients undergo exploratory laparotomy for diagnosis. Mortality approaches 50% one year after diagnosis. Treatment for EPS involves treating the underlying condition or eliminating possible inciting agents (i.e. peritoneal dialysis, medications, infections) and nutritional support, frequently with total parenteral nutrition. EPS-specific treatment depends on the disease stage. In the inflammatory stage, corticosteroids are the treatment of choice, while in the fibrotic stage, tamoxifen may be beneficial. In practice, distinguishing between stages may be difficult and both may be used. Surgical intervention, consisting of peritonectomy and enterolysis, is time-consuming and high-risk and is reserved for situations in which conservative medical therapy fails in institutions with surgical expertise in this area. Herein we review the available literature of the etiology, pathogenesis, diagnosis, and treatment of this rare, but potentially devastating disease.
Collapse
Affiliation(s)
- Christopher J Danford
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States
| | - Steven C Lin
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States
| | - Martin P Smith
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States
| | - Jacqueline L Wolf
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States
| |
Collapse
|
|
10
|
Noh SH, Ye BD, So H, Kim YS, Suh DJ, Yoon SN. Sclerosing encapsulating peritonitis in a long-term propranolol user. Intest Res 2016; 14:375-378. [PMID: 27799890 PMCID: PMC5083268 DOI: 10.5217/ir.2016.14.4.375] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 08/08/2015] [Accepted: 08/24/2015] [Indexed: 12/11/2022] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare cause of bowel obstruction that is characterized by the encasement of the small bowel by a thick, whitish, and fibrous membrane. The pathophysiology of SEP is poorly understood and preoperative diagnosis is difficult. Previous reports suggest that SEP may be linked to the chronic use of β-adrenergic blockers. A 46-year-old man with liver cirrhosis and end-stage renal disease on hemodialysis presented with recurrent abdominal pain and borborygmi. He had been taking propranolol to prevent bleeding from gastroesophageal varices for the past 15 years. Abdominal computed tomography showed ileal loops encapsulated by soft tissue with dilatation of the proximal small bowel on the right side of the abdomen. Barium follow-through showed conglomerated distal ileal loops with a cauliflower-like appearance. Explorative laparotomy revealed a thick, fibrous, whitish capsule encapsulating the ileal loops. The covering membrane was dissected and excised, resulting in an improvement in symptoms after surgery. Accordingly, a final diagnosis of SEP was made. Due to the lack of other apparent causes for SEP, we conclude that in this case, the long-term use of propranolol may be associated with the development of SEP.
Collapse
Affiliation(s)
- Se Hui Noh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.; Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hoonsub So
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu Seok Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Jin Suh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Nam Yoon
- Department of Colon & Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
|
11
|
Abstract
Chronic lupus peritonitis is uncommon, manifesting as ascites when other signs and symptoms of systemic lupus erythematosus are minimal, thus making diagnosis difficult. It is rarely the initial and only presenting symptom of systemic lupus erythematosus. We report such a case, which clinically and pathologically mimicked a malignant process. At laparotomy homogenous, thick, gray-white, firm tissue covered the bowel and other abdominal organs. Light microscopy showed a highly cellular, predominantly spindle-cell proliferation, raising the possible diagnosis of malignant peritoneal mesothelioma. A conservative approach was taken, and further investigation led to the definitive diagnosis of serositis associated with systemic lupus erythematosus. High-dose immunosuppressive therapy resulted in clinical and serologic improvement. The authors propose the term pseudosarcomatous sclerosing peritonitis to describe this unusually florid peritoneal reaction. The pathologic findings are discussed in the context of other reports of chronic lupus peritonitis, and the differential diagnosis of florid spindle-cell peritoneal reactions is considered.
Collapse
Affiliation(s)
- A. L. Finney
- Hanly Moir Pathology, New South Wales, The Western Australian Centre for Pathology & Medical Research, (PathCentre), Western Australia, Australia
| | - D. V. Spagnolo
- Department of Anatomical Pathology, Western Australia, Australia
| | | | - K. B. Shilkin
- Department of Anatomical Pathology, Western Australia, Australia; PathCentre, Locked Bag 2009, Nedlands 6009, Western Australia, Australia
| |
Collapse
|
|
12
|
Abdominal Sarcoidosis May Mimic Peritoneal Carcinomatosis. Case Rep Obstet Gynecol 2015; 2015:263945. [PMID: 26558122 PMCID: PMC4618331 DOI: 10.1155/2015/263945] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/18/2022] Open
Abstract
Sarcoidosis is a multisystem inflammatory disorder of unknown etiology. It shows a great variety of clinical presentation, organ involvement, and disease progression. Lungs and lymphoid system are the most common sites involved with a frequency of 90% and 30%, respectively. Extrapulmonary involvement of sarcoidosis is reported in 30% of patients and abdomen is the most frequent site. Furthermore, peritoneal involvement is extremely rare in sarcoidosis. The case presented here described peritoneal manifestations of sarcoidosis without involvement of lungs. A 78-year-old woman possessing signs of malignancy on blood test and abdominal magnetic resonance imaging underwent laparatomy with a suspicion of ovarian malignancy. The macroscopic interpretation during surgery was peritoneal carcinomatosis. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal biopsies, total omentectomy, and appendectomy were performed. Final histopathological result revealed the diagnosis of sarcoidosis. Clinicians must keep in mind that peritoneal sarcoidosis can mimic intra-abdominal malignancies.
Collapse
|
|
13
|
Ikeda Y, Sato Y, Kamihara Y, Hirakawa M, Onuma H, Takada K, Hayashi T, Sato T, Miyanishi K, Takimoto R, Kohune M, Nobuoka T, Noguchi H, Oi M, Honma H, Hirata K, Hasegawa T, Kato J. A case of idiopathic encapsulating peritoneal sclerosis with intractable ileus successfully treated by surgery and steroid therapy. Clin J Gastroenterol 2013; 6:295-8. [PMID: 26181733 DOI: 10.1007/s12328-013-0395-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 06/04/2013] [Indexed: 11/28/2022]
Abstract
Encapsulating peritoneal sclerosis (EPS) occurring without a history of peritoneal dialysis is rare. We report on a patient with idiopathic EPS following intractable ileus who was successfully treated by surgery and postoperative steroid therapy without any sign of recurrence. A 67-year-old woman was referred to our department for further treatment of intractable ileus. Abdominal CT scanning revealed wall thickening of the proximal jejunum. Double-balloon enteroscopy disclosed stenosis of the jejunum at 20 cm anally from the Treitz ligament, although the intestinal mucosa appeared normal without specific biopsy findings. In addition, FDG-PET showed no abnormal accumulation, thus discounting a malignant lesion. Since conservative therapy failed to improve the ileus, we performed an operation on her in order to release the ileus and make a histological diagnosis. Surgical findings included a whitish thickening of the serosa extending to the intestine and the whole mesentery. Accordingly, we made a diagnosis of idiopathic encapsulating peritoneal sclerosis because of her negative history of peritoneal dialysis, laparotomy or peritonitis, in addition to the above-noted findings. Postoperative oral administration of steroid has suppressed EPS recurrence. In patients with intractable ileus, EPS should be added to the list of differential diagnoses, even if they have not undergone peritoneal dialysis.
Collapse
Affiliation(s)
- Yuuki Ikeda
- Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Yasushi Sato
- Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Yuusuke Kamihara
- Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Masahiro Hirakawa
- Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hiroyuki Onuma
- Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Kohichi Takada
- Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Tsuyoshi Hayashi
- Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Tsutomu Sato
- Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Koji Miyanishi
- Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Rishu Takimoto
- Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Masayoshi Kohune
- Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Takayuki Nobuoka
- First Department of Surgery, Sapporo Medical University, Sapporo, Japan
| | - Hiroko Noguchi
- Department of Surgical Pathology, Sapporo Medical University, Sapporo, Japan
| | - Motoo Oi
- Department of Gastroenterology, Kyoritsu Gorinbashi Hospital, Sapporo, Japan
| | - Hisato Honma
- Department of Gastroenterology, Kyoritsu Gorinbashi Hospital, Sapporo, Japan
| | - Kohichi Hirata
- First Department of Surgery, Sapporo Medical University, Sapporo, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University, Sapporo, Japan
| | - Junji Kato
- Fourth Department of Internal Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo, 060-8543, Japan.
| |
Collapse
|
|
14
|
George V, Tammisetti VS, Surabhi VR, Shanbhogue AK. Chronic Fibrosing Conditions in Abdominal Imaging. Radiographics 2013; 33:1053-80. [DOI: 10.1148/rg.334125081] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
|
15
|
Tarquini R, Colagrande S, Rosselli M, Novelli M, Dolenti S, Valoriani A, Laffi G. Complete resolution of primary sclerosing peritonitis ("abdominal cocoon") following long term therapy for Tropheryma whipplei: a case report and review of literature. BMJ Case Rep 2009; 2009:bcr04.2009.1810. [PMID: 21709845 DOI: 10.1136/bcr.04.2009.1810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 53-year-old man was admitted to our internal medicine unit with intestinal obstruction and signs of systemic inflammatory disease. Clinical history was unremarkable until a few months earlier, when he began suffering from Achilles tendonitis. Diagnostic procedures, including laparotomy, revealed diffuse thickening of the peritoneum resembling sclerosing encapsulating peritonitis. Biopsies showed reactive fibrosis. No known secondary causes were found and surgery was technically not feasible. Clinical conditions worsened daily until, on the basis of the overall spectrum of clinical and radiological findings, Whipple's disease was hypothesised and specific therapy administered, with prompt clinical improvement. Complete disappearance of the cocoon was demonstrated at 1 year clinical/ultrasound/computed tomography follow-up.
Collapse
Affiliation(s)
- Roberto Tarquini
- Department of Internal Medicine, University of Florence, Azienda Ospedaliero-Universitaria Careggi. Viale Morgagni 85, Florence 50134, Italy
| | | | | | | | | | | | | |
Collapse
|
|
16
|
Peritoneal and pleural sarcoidosis: an unusual association - review and clinical report. Curr Opin Pulm Med 2008; 14:481-7. [PMID: 18664980 DOI: 10.1097/mcp.0b013e328304ae43] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To examine recent reports of serosal involvement in sarcoidosis. RECENT FINDINGS Peritoneal sarcoidosis continues to be a rare manifestation of the disease. Patients with peritoneal disease tend to be women between the ages of 20 and 40 years, and most commonly present with ascites and abdominal pain. Peritoneal involvement is not isolated, and sarcoid granulomas are often found elsewhere. Pleural disease is often manifested as pleural effusions. Patients with pleural disease are often older and usually have lymphocytic exudative effusions. SUMMARY Sarcoidosis should be in the differential in a young patient presenting with unexplained effusions and ascites.
Collapse
|
|
17
|
Abstract
Sclerosing peritonitis (also described as sclerosing obstructive peritonitis, encapsulating peritonitis, obliterative adhesive peritonitis, abdominal cocoon syndrome) is not well-known by the general surgeon; most reviews of this subject occur in the nephrology literature. Peritoneal dialysis and continuous hyperthermic peritoneal perfusion are the main causes. No controlled study exists to evaluate the optimal therapeutic approach. Pre-operative diagnosis is difficult since the clinical signs and radiologic findings are non-specific. Nevertheless, the diagnosis should be considered when small bowel obstruction with proximal dilatation, ascites, and thickened or calcified peritoneum are seen on imaging. The surgeon should recognize sclerosing peritonitis grossly when it is encountered and adapt his surgical strategy accordingly.
Collapse
Affiliation(s)
- J C Dutranoy
- Service de Chirurgie Générale et Digestive, Hôpital de Jolimont - Haine Saint Paul (Belgique).
| | | |
Collapse
|
|
18
|
|
|
19
|
Abstract
A 61-year-old female patient is described who presented with weight loss, steatorrhoea and enlargement of the pancreatic head. Surgical exploration for suspected pancreatic cancer revealed multiple peritoneal white spots, initially suggestive for peritoneal metastases or tuberculosis but finally identified as peritoneal sarcoidosis. Pancreatic insufficiency could not be proven in further studies. We found pancreas divisum as an additional cause for the pancreatic head mass, and steatorrhoea was due to late-onset oligosymptomatic coeliac disease. This case demonstrates diagnostic pitfalls when several rare disorders are manifest in a single patient. Coeliac disease and sarcoidosis might be sequels of similar immune responses to certain antigens.
Collapse
Affiliation(s)
- Karlheinz Kiehne
- Department of Internal Medicine, Universitätsklinikum Schleswig Holstein, Campus Kiel, Kiel, Germany.
| | | | | |
Collapse
|
|
20
|
Vijayaraghavan SB, Palanivelu C, Sendhilkumar K, Parthasarathi R. Abdominal cocoon: sonographic features. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2003; 22:719-721. [PMID: 12862272 DOI: 10.7863/jum.2003.22.7.719] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
An abdominal cocoon is a rare condition in which the small bowel is encased in a membrane. The diagnosis is usually established at surgery. Here we describe the sonographic features of this condition.
Collapse
|
|
21
|
Affiliation(s)
- Imad W Uthman
- Faculty of Medicine, American University of Beirut, Lebanon.
| | | | | |
Collapse
|
|
22
|
Al-Nafussi A, Wong NA. Intra-abdominal spindle cell lesions: a review and practical aids to diagnosis. Histopathology 2001; 38:387-402. [PMID: 11422475 DOI: 10.1046/j.1365-2559.2001.01119.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Intra-abdominal spindle cell lesions are uncommon and often present a diagnostic challenge. An important group of such lesions are the gastrointestinal stromal tumours. Other intra-abdominal spindle cell lesions include fibromatosis, various sarcomas-in particular, leiomyosarcoma, liposarcoma, and malignant peripheral nerve sheath tumour-and, in women, endometrial stromal sarcoma. Less common lesions are inflammatory myofibroblastic tumours, the mesenteric spindle cell reactive lesions, retroperitoneal fibrosis, and solitary fibrous tumour. A variety of intra-abdominal tumours of nonmesenchymal origin may have a spindle cell/sarcomatoid morphology; these include sarcomatoid carcinoma, malignant melanoma and, in women, sarcomatoid granulosa cell tumour. Finally, metastatic sarcomas from pelvic or extra-abdominal organs need also be considered. A set of practical aids to the diagnosis of intra-abdominal spindle cell lesions is presented to assist pathologists dealing with such lesions, particularly with regards to the consideration of differential diagnoses.
Collapse
Affiliation(s)
- A Al-Nafussi
- Department of Pathology, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
| | | |
Collapse
|
|
23
|
Abstract
The abdominal cocoon is a rare cause of intestinal obstruction most often found in adolescent girls from tropical and subtropical countries. It is characterized by a thick fibrotic sac covering the small bowel partially or completely, the etiology of which is unknown. A correct diagnosis is not often made preoperatively; however, following simple surgical release of the entrapped bowel, these patients usually do well. We report herein our experience of a case of abdominal cocoon with a brief review of the medical literature on this unusual disease entity.
Collapse
Affiliation(s)
- M Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi
| | | | | |
Collapse
|
|
24
|
Sillero JM, Calvet X, Musulen E, Diaz-Ruiz MJ, Tolosa C, Pardo A, Corcuera A, Malet A, Font J. Idiopathic pylephlebitis and idiopathic sclerosing peritonitis in a man with protein S deficiency. J Clin Gastroenterol 2001; 32:262-5. [PMID: 11246360 DOI: 10.1097/00004836-200103000-00020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Idiopathic pylephlebitis and primary sclerosing peritonitis are two highly unusual entities. To our knowledge, the association of the two diseases has not been described previously. We report a 42-year-old patient with a protein S deficiency who presented with fever and chills, in whom idiopathic pylephlebitis was diagnosed. A year later, the patient was readmitted because of recurrent vomiting and weight loss. An exploratory laparotomy yielded diagnosis of sclerosing peritonitis, which resolved after surgery. The short time interval between the processes suggests that they were related to each other, and also to the protein S deficiency.
Collapse
Affiliation(s)
- J M Sillero
- Department of Internal Medicine, Corporació Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
|
25
|
Uthman IW, Bizri AR, Shabb NS, Khury MY, Khalifeh MJ. Peritoneal sarcoidosis: case report and review of the literature. Semin Arthritis Rheum 1999; 28:351-4. [PMID: 10342393 DOI: 10.1016/s0049-0172(99)80020-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study was performed to report a patient with peritoneal sarcoidosis and review the literature for similar cases. METHODS We described the clinical presentation, course, and outcome of the patient, and reviewed the medical literature from 1966 till 1997 using MEDLINE and the key words sarcoidosis, scar, and peritoneum. RESULTS Our patient presented with a rapidly growing tumor-like mass at the site of an old appendectomy scar. Laparoscopy showed a large peritoneal mass and multiple small peritoneal nodules that were found to be noncaseating granulomas by pathology. The MEDLINE search uncovered only 16 cases of peritoneal sarcoidosis, most of which presented with ascites. CONCLUSION This case illustrates the need to consider sarcoidosis, in addition to infections and neoplasms, in the differential diagnosis of peritoneal nodules and exudative ascites.
Collapse
Affiliation(s)
- I W Uthman
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Lebanon
| | | | | | | | | |
Collapse
|
|
26
|
Deeb LS, Mourad FH, El-Zein YR, Uthman SM. Abdominal cocoon in a man: preoperative diagnosis and literature review. J Clin Gastroenterol 1998; 26:148-50. [PMID: 9563929 DOI: 10.1097/00004836-199803000-00013] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sclerosing encapsulating peritonitis, or abdominal cocoon, is a relatively rare cause of intestinal obstruction, described mostly in young adolescent girls. It is characterized by a thick fibrotic peritoneum that wraps the bowel in a concertinalike fashion with some adhesions. Because of its peculiar characteristics, this condition presents many difficulties in preoperative diagnosis. Recognition of the entity results in proper management and prevents unnecessary bowel resection. We report a man with intermittent intestinal obstruction and an abdominal cocoon encasing the small bowel that was diagnosed preoperatively by radiology. To the best of our knowledge, this represents the fourth male patient reported in the medical literature to develop this condition. We briefly review the literature and discuss the preoperative diagnosis and management of sclerosing encapsulating peritonitis.
Collapse
Affiliation(s)
- L S Deeb
- Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | | | | | | |
Collapse
|
|
27
|
Mori Y, Matsuo S, Sutoh H, Toriyama T, Kawahara H, Hotta N. A case of a dialysis patient with sclerosing peritonitis successfully treated with corticosteroid therapy alone. Am J Kidney Dis 1997; 30:275-8. [PMID: 9261041 DOI: 10.1016/s0272-6386(97)90064-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Sclerosing peritonitis (SCP) is a rare complication of peritoneal dialysis. Most of the patients with this serious complication have been treated in a symptomatic and conservative manner. Other patients have undergone risky surgical interventions. Recently it was reported that immunosuppressive therapy after renal transplantation was effective for this complication. A 56-year-old man developed sclerosing peritonitis 5 months after switching from peritoneal dialysis to hemodialysis because of ultrafiltration failure. The patient had ongoing inflammatory signs and symptoms, and corticosteroid therapy was commenced. His condition was dramatically improved within 1 week, and he is now well on an outpatient basis with the maintenance dosage of corticosteroid. This is the first report of a patient with peritoneal dialysis-related SCP who responded favorably to corticosteroid therapy alone.
Collapse
Affiliation(s)
- Y Mori
- The Third Department of Internal Medicine, Nagoya University School of Medicine, Showa-ku, Japan
| | | | | | | | | | | |
Collapse
|
|
28
|
McLaughlin K, Butt G, Madi A, McMillan M, Mactier R. Sclerosing peritonitis occurring in a hemodialysis patient. Am J Kidney Dis 1996; 27:729-32. [PMID: 8629636 DOI: 10.1016/s0272-6386(96)90111-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The pathogenesis of sclerosing peritonitis is poorly understood. In patients with end-stage renal failure, it has been described in association with continuous ambulatory peritoneal dialysis (CAPD), although it has not been described in patients treated exclusively by hemodialysis. We present a case of sclerosing peritonitis occurring in a 47-year-old man who was treated solely by hemodialysis. Additionally, the patient was diagnosed as having "nephrogenic ascites" 5 years before developing sclerosing peritonitis, and we discuss a possible link between these two conditions.
Collapse
|
|
29
|
Bhandari S. Recovery of gastrointestinal function after renal transplantation in patients with sclerosing peritonitis secondary to continuous ambulatory peritoneal dialysis. Am J Kidney Dis 1996; 27:604. [PMID: 8678075 DOI: 10.1016/s0272-6386(96)90176-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
|
30
|
Abstract
Sclerosing encapsulating peritonitis (SEP), idiopathic or secondary, is a form of intraperitoneal fibrosclerosis that causes intestinal obstruction. In the case of a 41-year-old man with dialysis-induced SEP presented here, we show that intraperitoneal hemorrhage may play an important pathogenetic role and that the process may develop in < or = 12 weeks. Regardless of cause, the treatment of obstruction is operative, with dissection of the encasing membrane from the intestine and separation of adherent loops of small bowel until they are laid free and returned to their normal configuration. The prognosis after appropriate operative therapy is good but depends on coexisting diseases.
Collapse
Affiliation(s)
- O Cohen
- Department of Surgery A, Carmel Hospital, Haifa, Israel
| | | | | | | | | |
Collapse
|