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Nam SJ, Song SH, Lee SH, Jeung SY, Ah JG, Lee SH, Ryu MO. Peritoneal carcinomatosis with desmoplasia and osseous metaplasia mimicking encapsulating peritoneal sclerosis in a cat: case report. Front Vet Sci 2023; 10:1298736. [PMID: 38105775 PMCID: PMC10722156 DOI: 10.3389/fvets.2023.1298736] [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: 09/22/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023] Open
Abstract
A 13-year-old neutered male Korean short-hair cat presented with anorexia, lethargy, and a severely distended abdomen, suggestive of ascites. Abdominocentesis yielded serosanguineous fluid. A subsequent diagnostic workup, including blood tests, ascitic fluid analysis, imaging studies [radiography, ultrasound, and computed tomography (CT)], and histopathological examination, was performed to identify the underlying cause. Imaging studies revealed characteristics of encapsulating peritoneal sclerosis (EPS) such as peritoneal thickening, fat stranding, and calcification. During laparotomy, fibrous membranes encapsulating the abdominal organs and ascites were observed, and multiple calcified regions were detected on the abdominal wall. Histopathological analysis confirmed the diagnosis of poorly differentiated invasive malignant neoplasms, which were further classified as carcinomatosis based on positive cytokeratin and negative vimentin immunohistochemistry results. To our knowledge, this is the first report of sclerosing peritoneal carcinomatosis with osseous metaplasia in a cat.
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Affiliation(s)
- So-Jeong Nam
- VIP Animal Medical Center KR, Seoul, Republic of Korea
| | - Sun-Hye Song
- VIP Animal Medical Center KR, Seoul, Republic of Korea
| | | | | | - Jae Gon Ah
- VIP Animal Medical Center KR, Seoul, Republic of Korea
| | - Su-Hyung Lee
- Section of Surgical Sciences, Epithelial Biology Center, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Min-Ok Ryu
- Laboratory of Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
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Srisajjakul S, Prapaisilp P, Bangchokdee S. Imaging pearls and differential diagnosis of encapsulating peritoneal sclerosis: Emphasis on computed tomography. Clin Imaging 2023; 94:116-124. [PMID: 36527797 DOI: 10.1016/j.clinimag.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/20/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a severe peritoneal fibrotic reaction most frequently identified as a complication of peritoneal dialysis. EPS is a complex condition whose management requires multidisciplinary input from radiologists, gastroenterologists, nephrologists, surgeons, and dietitians. EPS carries significant morbidity and mortality, primarily due to bowel obstruction that results in intestinal failure, malnutrition, and sepsis. The nondialysis causes of EPS include tuberculous peritonitis, prior abdominal surgery, beta-blocker medication use, and endometriosis. The clinical symptoms of EPS are nausea, vomiting, and abdominal pain, all of which appear to be associated with bowel obstruction. The diagnosis of EPS needs three pillars to be met: clinical features, radiological evaluation, and histopathological analysis. The disease is frequently progressive and can be fatal. Computed tomography is the gold standard imaging modality for the detection of peritoneal abnormalities and encapsulation of bowel loops by thick adhesions or fibrosis (cocooning). Computed tomography also aids in making a differential diagnosis. Unfortunately, the diagnosis of EPS is often delayed because clinical findings are not specific and may resemble other peritoneal diseases. Radiologists should be familiar with the clinical impacts and related imaging features of EPS and realize when to seek them to facilitate timely and proper treatment.
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Affiliation(s)
- Sitthipong Srisajjakul
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Patcharin Prapaisilp
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Brückner M, Bogisch S. Laparoscopic ovariectomy in a dog with type III sclerosing encapsulating peritonitis and literature review. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2022; 50:138-143. [PMID: 35523167 DOI: 10.1055/a-1811-4052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sclerosing encapsulating peritonitis is a rare and not well-recognized disease in veterinary medicine. A 14-month-old female intact mixed-breed dog was diagnosed with sclerosing encapsulating peritonitis (SEP) at the age of 5 months after a routine work-up including biopsies from an exploratory laparotomy. Symptomatic treatment with an immunosuppressive dose of prednisolone was started, but dose reduction was unsuccessful. Combined treatment with tamoxifen, a selective estrogen receptor modulator used for its TGF-β1 suppression of fibroblasts was discussed; the owner was informed about the risk for developing a pyometra. About one year later the owner wanted to spay her dog and an ovariectomy was recommended, especially due to the extensive adhesions. A laparoscopic approach was chosen to reduce the amount of intraoperative tissue manipulation and inflammation, as well as to minimize the size of the incision. The dog continues to be doing well one year after surgery and prednisolone could be reduced to a low maintenance dose after surgery; so far, the addition of tamoxifen was not required. In selected cases, laparoscopy appears as a safe alternative in patients with adhesions, but the surgeon should always be prepared to convert in case of impaired vision, especially in the absence of tactile sensation. This case report is the first description of laparoscopy in a dog with SEP. Laparoscopy may serve as an easily accomplished minimally invasive method to diagnose SEP, but further studies are required.
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Zhang F, Diao X, Li C, Peng Y, Lin J, Xu R, Yang X, Guan J. Adverse factors on nonenhanced abdominal CT for long-term continuous ambulatory peritoneal dialysis: a comparative study between patients who withdraw from and maintain long-term peritoneal dialysis. Abdom Radiol (NY) 2021; 46:5277-5283. [PMID: 34389872 PMCID: PMC8363491 DOI: 10.1007/s00261-021-03238-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 12/02/2022]
Abstract
Purpose To investigate the imaging features of patients with long-term continuous ambulatory peritoneal dialysis (CAPD) on nonenhanced abdominal CT and to identify adverse factors for long-term CAPD. Methods A total of 109 patients with less than 5 years of CAPD for peritoneal ultrafiltration failure who switched to hemodialysis (withdrawal group) and 23 patients with more than 10 years of CAPD (long-term group) were retrospectively enrolled. Nonenhanced CT manifestations in both groups were compared, including thickening and calcification of the parietal peritoneum, calcification of the mesangial margin and free margin of the small intestine wall, and calcification of the mesentery and abdominal aorta. A risk stratification model was proposed based on CT manifestations with statistically significant differences. Results The presence of the following CT findings was significantly different between two groups: extensive thickening of the parietal peritoneum (78.9% vs. 21.7%, P < 0.01); severe calcification of the parietal peritoneum (60.6% vs. 8.7%, P < 0.01); calcification of the mesentery (32.1% vs. 4.3%, P < 0.05); and calcification of the free margin of the small intestine wall (49.5% vs. 13.0%, P < 0.05). However, there was no significant difference in calcification of the mesangial margin of the small intestine wall (40.3% vs. 30.4%) or in abdominal aortic calcification (56.9% vs. 61.1%) (P > 0.05). The area under the receiver operating characteristic curve (AUC) was 0.906 (sensitivity 87.6% and specificity 82.6%). Conclusion Extensive thickening of the parietal peritoneum, severe calcification of the parietal peritoneum, and calcification of the mesentery and the free margin of the small intestine wall are adverse factors for long-term CAPD.
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Sivakumar J, Brown G, Galea L, Choi J. An intraoperative diagnosis of sclerosing encapsulating peritonitis: a case report. J Surg Case Rep 2020; 2020:rjaa329. [PMID: 32934790 PMCID: PMC7480954 DOI: 10.1093/jscr/rjaa329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/27/2020] [Indexed: 12/23/2022] Open
Abstract
Primary sclerosing encapsulating peritonitis (SEP) is an idiopathic and rare condition characterized by chronic peritoneal inflammation. We describe the case of an intraoperative diagnosis of SEP, presenting as a mimicker of small bowel obstruction. The patient was a 59-year-old male with suspected small bowel obstruction. On exploratory laparotomy, it was noted that there was thick fibrous tissue involving the visceral and parietal peritoneum enveloping grossly dilated loops of small bowel. This case reports on the histopathological features of peritoneal biopsies as well as radiological findings. There is no consensus regarding the standard management for idiopathic SEP. The present case demonstrates a significant improvement in the patient’s condition with conservative management alone. A critical teaching point is that in the absence of an obvious cause, SEP is a rare but important differential diagnosis for surgeons to consider in the context of recurrent bowel obstruction.
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Affiliation(s)
- Jonathan Sivakumar
- Clinical Institute of General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Victoria, Australia
| | - Gregor Brown
- Clinical Institute of General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Victoria, Australia
| | - Laurence Galea
- Department of Anatomical Pathology, Melbourne Pathology, Melbourne, Victoria, Australia
| | - Julian Choi
- Clinical Institute of General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Victoria, Australia
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Kang JH. A rare case of intestinal obstruction: Sclerosing encapsulating peritonitis of unknown cause. Turk J Emerg Med 2020; 20:152-155. [PMID: 32832736 PMCID: PMC7416848 DOI: 10.4103/2452-2473.290068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/23/2020] [Indexed: 12/15/2022] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is characterized by the partial or complete enclosing of the small intestines by a thick fibro-collagenous membrane, which can cause recurrent intestinal obstruction. SEP is a clinically rare disease, and the major risk factor is peritoneal dialysis (PD). Early diagnosis of SEP is an important factor in the patient's prognosis, but it is clinically difficult. A 52-year-old woman visited the emergency department (ED) with a 2-day history of abdominal pain and vomiting. She had a history of liver cirrhosis with chronic hepatitis B, but no history of PD, and she underwent a biopsy of the peritoneum by laparoscopy a month ago. On physical examination, there were peritoneal irritation signs on the right lower quadrant (RLQ). Abdominal computed tomography (CT) showed dilated small intestinal loops clustered in the RLQ, which were surrounded by a sac-like, thick fibrous membrane. Based on CT findings, small intestinal obstruction due to SEP was early diagnosed in the ED. Emergency physicians should include SEP in the differential diagnosis of the cause of intestinal obstruction. Abdominal CT is a useful modality for the early diagnosis of SEP in the ED.
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Affiliation(s)
- Jeong Ho Kang
- Department of Emergency Medicine, Jeju National University School of Medicine, Jeju-do, Republic of Korea
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Carroll KA, Wallace ML, Hill TL, Bartges JW, Ruby JL, Mulder AT, Helmick JI. Pyloric outflow obstruction secondary to sclerosing encapsulating peritonitis in a dog. Aust Vet J 2019; 98:11-16. [PMID: 31667833 DOI: 10.1111/avj.12887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 09/29/2019] [Accepted: 10/03/2019] [Indexed: 11/30/2022]
Abstract
A 6-year-old, male neutered mixed breed dog was presented emergently with a three-week history of hyporexia, vomiting, diarrhoea and weight loss. Upon examination, the patient was dull, had generalised muscle atrophy, moderate abdominal pain and a mild amount of peritoneal effusion. A fluid-filled, distended, corrugated small bowel with marked gastroparesis and moderate peritoneal effusion was noted on abdominal ultrasonography. Endoscopy revealed hyperaemic and friable mucosa and a subjectively narrowed pylorus. Emergency exploratory celiotomy was performed due to worsening patient condition and revealed thick, diffuse, fibrous adhesions of the abdominal cavity. Based on these findings, sclerosing encapsulating peritonitis (SEP) was suspected. A large mass of omentum adjacent to the greater curvature of the stomach had caused a pyloric outflow obstruction. Adhesiolysis was attempted but was unsuccessful due to the friability of the small intestines. The dog was humanely euthanased under anaesthesia. A diagnosis of SEP was confirmed via necropsy. No underlying cause was identified. This is the first known case of a pyloric outflow obstruction secondary to SEP in a dog. Although rare, this condition should be considered as a differential for dogs with signs of a pyloric outflow obstruction with concurrent ascites and abdominal pain, hyporexia, vomiting and diarrhoea.
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Affiliation(s)
- K A Carroll
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, 30602
| | - M L Wallace
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, 30602
| | - T L Hill
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, 30602
| | - J W Bartges
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, 30602
| | - J L Ruby
- Department of Biosciences and Diagnostic Imaging, College of Veterinary Medicine, University of Georgia, Athens, Georgia, 30602
| | - A T Mulder
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, 30602
| | - J I Helmick
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, 30602
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Computed Tomography Features of Encapsulating Peritoneal Sclerosis. Can Assoc Radiol J 2019; 70:233-238. [DOI: 10.1016/j.carj.2018.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 02/07/2023] Open
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The use of computed tomography in the diagnosis of abdominal cocoon. Clin Imaging 2018; 50:171-174. [PMID: 29602067 DOI: 10.1016/j.clinimag.2018.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/13/2018] [Accepted: 03/19/2018] [Indexed: 12/27/2022]
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Kong YX, Strasser SI, McCaughan GW, Crawford M, Verran DJ. Sclerosing peritonitis post liver transplantation: a rare condition where surgery is an important treatment option. ANZ J Surg 2017; 88:E424-E428. [PMID: 28782907 DOI: 10.1111/ans.14128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 04/23/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sclerosing peritonitis (SP) is a rare but potentially fatal complication following orthotopic liver transplantation (OLT). The definitive surgical management is via a laparotomy peritonectomy and enterolysis procedure, but this carries risks particularly in the immunosuppressed transplant patient population. The natural history of SP is known from a handful of case reports and series, which mostly report de novo cases arising early on following OLT. The aim of this study was to identify all cases of de novo SP following OLT and the outcomes of management. METHODS Cases of SP post OLT were identified from the Australian National Liver Transplantation Unit (New South Wales) database of all 1393 adult patients. RESULTS Three cases of SP were diagnosed between 2 and over 9 years post-transplantation. Two patients proceeded to laparotomy and a peritonectomy and enterolysis procedure of the cocooned bowel. The third was managed conservatively due to a relatively indolent course and their medical co-morbidities. CONCLUSION SP should be considered in the differential diagnosis in patients post OLT presenting with symptoms of bowel obstruction, even years following transplantation. Surgery may be required in order to achieve a satisfactory outcome in some cases.
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Affiliation(s)
- Yvonne X Kong
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Simone I Strasser
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Geoffrey W McCaughan
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael Crawford
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Deborah J Verran
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Stuart S, Stott D, Goode A, Cash CJ, Davenport A. Can radiological assessment of abdominal computerized scans diagnose encapsulating peritoneal sclerosis in long-term peritoneal dialysis patients? Nephrology (Carlton) 2017; 22:19-24. [PMID: 26730546 DOI: 10.1111/nep.12718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/08/2015] [Accepted: 12/29/2015] [Indexed: 12/11/2022]
Abstract
AIM Encapsulating peritoneal sclerosis (EPS) is a rare but potentially devastating complication of long-term peritoneal dialysis (PD). Changes to the peritoneal membrane occur with duration of PD therapy. To determine the potential effect of prospective computerized tomography (CT) scanning, we reviewed the scans of patients who had developed EPS compared with those without EPS. METHODS We retrospectively compared CT scans that had been prospectively performed in a screening program for PD patients after 4 years of PD and compared scans from 18 patients with confirmed EPS and 26 vintage matched controls without EPS. Anonymized scans were reported independently by two blinded experienced radiologists. RESULTS Peritoneal thickening, calcification, bowel tethering, thickening and dilatation were significantly more commonly reported in the EPS group. Total combined radiological scores, also including septation within peritoneal fluid, were significantly higher in the EPS group and the greatest for those who died as a consequence of EPS. Simplified scoring based on presence or absence, then for a score of ≥3.0, gave a receiver operating characteristic value of 0.87 for EPS, with a sensitivity of 78% and specificity of 85%, respectively. Inter-observer agreement varied from poor to good, being the greatest for calcification and bowel dilatation and the lowest for peritoneal thickening. CONCLUSION CT scan reporting can differentiate EPS from peritoneal changes associated with duration of PD therapy. Severity of abnormalities was associated with clinical outcomes. However, inter-observer agreement varies with different radiological appearances, and future studies are required to determine weighting of radiological changes to provide prognostic information for clinicians and patients.
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Affiliation(s)
- Sam Stuart
- Department of Radiology, Royal Free Hospital, London, UK
| | - David Stott
- Faculty of Health and Human Sciences, University of Hertfordshire, Hatfield, UK
| | - Antony Goode
- Department of Radiology, Royal Free Hospital, London, UK
| | | | - Andrew Davenport
- UCL Center for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
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The peritoneal sieving of sodium: a simple and powerful test to rule out the onset of encapsulating peritoneal sclerosis in patients undergoing peritoneal dialysis. J Nephrol 2016; 31:137-145. [DOI: 10.1007/s40620-016-0371-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 12/06/2016] [Indexed: 10/20/2022]
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Affiliation(s)
- Dinesh Singh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90, Yishun Central, Singapore, 768828, Singapore.
| | - Ashish Chawla
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90, Yishun Central, Singapore, 768828, Singapore
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Yang CS, Kim D. Unusual intestinal obstruction due to idiopathic sclerosing encapsulating peritonitis: a report of two cases and a review. Ann Surg Treat Res 2016; 90:231-4. [PMID: 27073795 PMCID: PMC4826987 DOI: 10.4174/astr.2016.90.4.231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 01/26/2016] [Accepted: 02/15/2016] [Indexed: 02/08/2023] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction that is characterized by a thick fibrotic membrane encasing the small intestine like a cocoon. Accurate preoperative diagnosis is often difficult. We present 2 cases of SEP that were diagnosed preoperatively by contrast-enhanced computed tomography scan. A 38-year-old man and a 56-year-old woman were admitted to Daegu Catholic University Medical Center because of recurrent intestinal obstruction. We performed exploratory laparotomy with doubt of the preoperative diagnosis of SEP. We confirmed the diagnosis of SEP on laparotomy and performed adhesiolysis. Both patients recovered successfully and had no signs of recurrence. A better awareness of SEP and its radiological features should lead to more correct preoperative diagnosis and result in more appropriate management, including surgery.
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Affiliation(s)
- Chun-Seok Yang
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Daedong Kim
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
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Surgical treatment and perioperative management of idiopathic abdominal cocoon: single-center review of 65 cases. World J Surg 2015; 38:1860-7. [PMID: 24519587 DOI: 10.1007/s00268-014-2458-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The abdominal cocoon (AC) is a condition in which a variable length of healthy small bowel is enveloped in a fibrocollagenous membrane, giving the appearance of a cocoon. Early experiences with treatment were associated with high mortality and morbidity rates and a low preoperative diagnostic rate, leading to underestimation of the treatment benefit of surgery. METHODS We retrospectively reviewed the medical records of 65 patients who were diagnosed as having AC from 2001 to 2011. The clinical data, surgical intervention, and perioperative management were carefully reviewed. RESULTS The 65 patients (57 male, 8 female) had a median age of 39 years (range 14-79 years). Patients who received preoperative nutritional support had higher rate of grade 0 complications (p = 0.012) and a lower rate of grade II complications (p = 0.012) than those without nutritional support. Intestinal stenting during surgical intervention also decreased both grade I (p = 0.012) and grade II (p = 0.007) complications. Patients who received preoperative nutritional support and underwent intestinal stenting had a lower rate of postoperative complications (p < 0.05). In addition, patients with preoperative nutritional support were more satisfied postoperatively (p = 0.018) than those without nutritional support. This was also observed in patients with intestinal stenting versus those without it (p = 0.027). CONCLUSIONS Our single-center study with a large number of patients provided evidence regarding the epidemiology of AC. Preoperative nutritional support and intestinal stenting significantly reduced postoperative complications and, more importantly, increased postoperative satisfaction.
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Veiga-Parga T, Hecht S, Craig L. IMAGING DIAGNOSIS-SCLEROSING ENCAPSULATING PERITONITIS IN A DOG. Vet Radiol Ultrasound 2015; 56:E65-9. [PMID: 26095283 DOI: 10.1111/vru.12273] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/05/2015] [Indexed: 11/29/2022] Open
Abstract
An approximately 5-month-old American Staffordshire terrier was presented with a history of recurrent peritoneal effusion. Abdominal radiographs and ultrasound showed a loculated effusion in the ventral abdomen with dorsal displacement of abdominal organs, hepatomegaly and rounding of liver and splenic margins. Computed tomography demonstrated centrally located gastrointestinal segments surrounded by a thin soft tissue band and a thickened peritoneal lining. At necropsy a fibrous membrane continuous with liver and splenic capsules encapsulated all abdominal organs. Microscopically the abdominal wall and fibrous capsule consisted of an irregular thick layer of hypocellular connective tissue. The final diagnosis was sclerosing encapsulating peritonitis.
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Affiliation(s)
- Tamara Veiga-Parga
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, 37996-4542
| | - Silke Hecht
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, 37996-4542
| | - Linden Craig
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, 37996-4542
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Robert B, Hanes A. Abdominal cocoon, an uncommon cause of intestinal obstruction. Presse Med 2015; 44:352-4. [PMID: 25578548 DOI: 10.1016/j.lpm.2014.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 09/24/2014] [Accepted: 10/09/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- Brice Robert
- Amiens North Hospital, department of digestive radiology, 80054 Amiens cedex 01, France.
| | - Adina Hanes
- Amiens North Hospital, department of metabolic and digestive surgery, 80054 Amiens cedex 01, France
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Li M, Zhu W, Li Y, Jiang J, Li J, Li N. Long intestinal tube splinting prevents postoperative adhesive small-bowel obstruction in sclerosing encapsulating peritonitis. BMC Gastroenterol 2014; 14:180. [PMID: 25420530 PMCID: PMC4289301 DOI: 10.1186/1471-230x-14-180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 08/11/2014] [Indexed: 01/23/2023] Open
Abstract
Background Sclerosing encapsulating peritonitis (SEP) is a rare cause of small-bowel obstruction. The optimal treatment for this condition remains controversial. Methods In this study, we performed a retrospective analysis of the data of 44 patients who underwent surgery for SEP between December 2001 and 2008 at our hospital. The long-term follow-up data of the patients were assessed for the recurrence of adhesive small-bowel obstruction (ASBO), and patient survival was assessed to evaluate the efficiency of tube splinting in the prevention of postoperative ASBO. Results Of the 44 patients who underwent surgery for SEP, 33 underwent simple enterolysis along with tube splinting, while the remaining underwent only simple enterolysis. The median follow-up period was 79.4 ± 24.8 months (range: 8–123 months). The rate of complications was 9.1% and 6.1% in the simple enterolysis group and tube-splinting group, respectively (P = 0.73). The recurrence rate of ASBO was lower in the tube-splinting group (6.7%) than in the simple enterolysis group (40%) (P = 0.02). Conclusion Our findings indicate that tube splinting may be more useful than simple enterolysis alone in preventing the recurrence of ASBO in patients with SEP.
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Affiliation(s)
| | | | | | | | | | - Ning Li
- Department of General Surgery, Jinling Hospital, Medicine School of Nanjing University, NO 305 East Zhongshan Road, Nanjing, Jiangsu Province, China.
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Wong YY, Wong PN, Mak SK, Chan SF, Cheuk YY, Ho LY, Lo KY, Lo MW, Lo KC, Tong GMW, Wong AKM. Persistent sterile peritoneal inflammation after catheter removal for refractory bacterial peritonitis predicts full-blown encapsulating peritoneal sclerosis. Perit Dial Int 2013; 33:507-14. [PMID: 23907832 DOI: 10.3747/pdi.2012.00281] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Encapsulating peritoneal sclerosis (EPS) is the most serious complication of peritoneal dialysis, having high morbidity and mortality. To improve outcomes, early diagnosis is needed to direct treatment during the early inflammatory phase. However, in the early inflammatory phase, clinical features are nonspecific, and no reliable diagnostic criteria have been established. Because bacterial peritonitis and termination of dialysis are two important risk factors triggering the progression of EPS, patients with refractory bacterial peritonitis necessitating dialysis catheter removal are at particularly high risk of developing EPS. Many of these patients might indeed experience non-resolving sterile peritonitis (probably the inflammatory phase of EPS) before progression to full-blown disease (that is, the presence of intestinal obstruction). We undertook a retrospective study to compare, in this particular situation, the clinical characteristics of patients with or without sterile peritoneal inflammation, assessing their clinical outcomes in terms of short-term mortality and the chance of developing full-blown EPS. METHODS Our retrospective review included 62 patients whose dialysis catheter was removed because of refractory peritonitis between January 2005 and December 2010. RESULTS Of the 62 patients identified, 39 (63%) had persistent sterile peritoneal inflammation ("high-risk" group, n = 39), and 23 (37%) had resolution of inflammation without significant intra-abdominal collection after catheter withdrawal ("control" group, n = 23). Compared with the control group, the high-risk group had a significantly longer PD duration (71.6 ± 43.3 months vs 42.3 ± 29.9 months, p = 0.003), a higher dialysate-to-plasma ratio (D/P) of creatinine (0.768 ± 0.141 vs 0.616 ± 0.091, p = 0.004), and a higher computed tomography score for EPS (7.69 ± 2.98 vs 1.00 ± 1.00, p < 0.001). During the 6-month study period, the high-risk group had a higher chance of developing full-blown EPS (31% vs 0%, p = 0.002) and a higher 6-month all-cause mortality (36% vs 4.3%, p = 0.004). CONCLUSIONS Persistent sterile peritoneal inflammation was common after dialysis catheter removal for refractory bacterial peritonitis, and the patients with such inflammation were at high risk of progression to full-blown EPS.
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Affiliation(s)
- Yuk-Yi Wong
- Renal Unit,1 Department of Medicine and Geriatrics, and Department of Radiology,2 Kwong Wah Hospital, Hong Kong SAR, PR China
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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: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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21
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Singh B, Gupta S. Abdominal cocoon: a case series. Int J Surg 2013; 11:325-8. [PMID: 23459185 DOI: 10.1016/j.ijsu.2013.02.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 02/13/2013] [Accepted: 02/14/2013] [Indexed: 12/11/2022]
Abstract
We describe a series of 18 cases of abdominal cocoon in patients presenting with features of small intestinal obstruction or perforative peritonitis, nine of whom had tubercular aetiology while the rest were idiopathic. Manifestations of abdominal tuberculosis such as mesenteric abscesses, enlarged and caseating mesenteric lymph nodes, and tubercles over the bowel serosa were found in only 55% patients who were ultimately diagnosed to have Tubercular aetiology. We conclude that a high index of suspicion for this rare cause of a common surgical emergency is desirable.
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Affiliation(s)
- Brijendra Singh
- Dept of Surgical Gastroenterology, Regency Hospital, Kanpur, India.
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22
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Katz DS, Scheirey CD, Bordia R, Hines JJ, Javors BR, Scholz FJ. Computed Tomography of Miscellaneous Regional and Diffuse Small Bowel Disorders. Radiol Clin North Am 2013. [DOI: 10.1016/j.rcl.2012.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Araújo JDAB, Martines JADS, Martines BMR, da Silva AF, Lovisolo SM, de Castro CC. Idiopathic sclerosing encapsulating peritonitis: an uncommon cause of intestinal obstruction. AUTOPSY AND CASE REPORTS 2012; 2:51-56. [PMID: 31528580 PMCID: PMC6735565 DOI: 10.4322/acr.2012.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 07/31/2012] [Indexed: 12/18/2022] Open
Abstract
Sclerosing encapsulating peritonitis (SEP), also called encapsulating peritonitis, is a rare and benign cause of intestinal obstruction of unknown etiology. Its onset may be acute or subacute although there are some reports with a two-month history. More commonly, this entity is secondary to chronic peritoneal dialysis, ventriculoperitoneal and peritoneovenous shunting, the use of β-blockers and systemic lupus erythematous. Recurrent episodes of bacterial peritonitis, intestinal tuberculosis, sarcoidosis, familial Mediterranean fever, gastrointestinal cancer, liver transplantation, intra-abdominal fibrogenic foreign bodies, and luteinized ovarian thecomas are also related to SEP. The idiopathic presentation is more rare. Abdominal pain, nausea, vomiting, weight loss, malnutrition, and clinically palpable mass characterize the clinical features. Diagnosis is frequently made with gross findings during surgery, imaging workup and histopathology. The authors report the case of a 36-year-old male patient with a 10-day history of abdominal pain that was operated on because of intestinal obstruction. Diagnosis was made preoperatively and confirmed by the intraoperative findings and histopathology.
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Affiliation(s)
| | | | | | - Adriano Ferreira da Silva
- Diagnostic Imaging Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Silvana Maria Lovisolo
- Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Cláudio Campi de Castro
- Diagnostic Imaging Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil.,Department of Radiology - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
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da Silva N, Rocha S, Rocha L, Faria S, Costa T, Mota C. Post-transplantation encapsulating peritoneal sclerosis in a pediatric patient. Pediatr Nephrol 2012; 27:1583-8. [PMID: 22527536 DOI: 10.1007/s00467-012-2176-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 03/18/2012] [Accepted: 03/20/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Encapsulating peritoneal sclerosis (EPS) is a serious complication of long-term peritoneal dialysis (PD), but only a few cases have been described in the pediatric patient population. There is no established medical treatment, and surgery has been reported with variable success. The number of reports of EPS being successfully treated with tamoxifen, based on its anti-fibrotic effects, are increasing. The role of sirolimus, an mTOR inhibitor with immunomodulatory and anti-proliferative properties, has been less well-defined. CASE-DIAGNOSIS/TREATMENT A 17-year-old kidney transplant recipient, with a previous cumulative time on PD of 8 years and 3 months, developed severe bowel obstruction 8 months after undergoing a second kidney graft. Her immunosuppressive regimen consisted of tacrolimus, mycophenolate mofetil, and prednisolone. The patient underwent laparotomy, which revealed multiple thick leathery adhesions with an encapsulated small bowel. Enterolysis was performed, and total parenteral nutrition was commenced after surgery to provide an adequate food intake. Treatment with tamoxifen was initiated, but the patient developed significant liver toxicity 2 weeks later, and the drug was withdrawn. The immunosuppressive regimen was changed to an increased dose of prednisolone, and tacrolimus was replaced with sirolimos. At 20 months of follow-up, the patient remains symptom-free, with a functioning kidney transplant. CONCLUSION Although EPS is a very rare condition in the pediatric population, it should be considered when a child or adolescent with a long-term history of PD presents with nonspecific gastrointestinal symptoms or with signs of bowel obstruction. There is an urgent need for alternative immunosuppressive protocols. The use of sirolimus in this group of patients remains controversial.
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Affiliation(s)
- Nicole da Silva
- Nephrology Department, Hospital Maria Pia, Centro Hospitalar do Porto, Rua da Boavista, 4050-111, Porto, Portugal.
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25
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Akoh JA. Peritoneal dialysis associated infections: An update on diagnosis and management. World J Nephrol 2012; 1:106-22. [PMID: 24175248 PMCID: PMC3782204 DOI: 10.5527/wjn.v1.i4.106] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 06/09/2012] [Accepted: 06/20/2012] [Indexed: 02/06/2023] Open
Abstract
Peritoneal dialysis (PD) is associated with a high risk of infection of the peritoneum, subcutaneous tunnel and catheter exit site. Although quality standards demand an infection rate < 0.67 episodes/patient/year on dialysis, the reported overall rate of PD associated infection is 0.24-1.66 episodes/patient/year. It is estimated that for every 0.5-per-year increase in peritonitis rate, the risk of death increases by 4% and 18% of the episodes resulted in removal of the PD catheter and 3.5% resulted in death. Improved diagnosis, increased awareness of causative agents in addition to other measures will facilitate prompt management of PD associated infection and salvage of PD modality. The aims of this review are to determine the magnitude of the infection problem, identify possible risk factors and provide an update on the diagnosis and management of PD associated infection. Gram-positive cocci such as Staphylococcus epidermidis, other coagulase negative staphylococcoci, and Staphylococcus aureus (S. aureus) are the most frequent aetiological agents of PD-associated peritonitis worldwide. Empiric antibiotic therapy must cover both gram-positive and gram-negative organisms. However, use of systemic vancomycin and ciprofloxacin administration for example, is a simple and efficient first-line protocol antibiotic therapy for PD peritonitis - success rate of 77%. However, for fungal PD peritonitis, it is now standard practice to remove PD catheters in addition to antifungal treatment for a minimum of 3 wk and subsequent transfer to hemodialysis. To prevent PD associated infections, prophylactic antibiotic administration before catheter placement, adequate patient training, exit-site care, and treatment for S. aureus nasal carriage should be employed. Mupirocin treatment can reduce the risk of exit site infection by 46% but it cannot decrease the risk of peritonitis due to all organisms.
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Affiliation(s)
- Jacob A Akoh
- Jacob A Akoh, South West Transplant Centre, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, United Kingdom
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26
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Chuang SH, Yang WC, Yang CY, Li SY. Encapsulating peritoneal sclerosis and aortic calcification with near-total occlusion. J Emerg Med 2012; 42:695-697. [PMID: 20692787 DOI: 10.1016/j.jemermed.2010.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 01/29/2010] [Accepted: 05/09/2010] [Indexed: 05/29/2023]
Affiliation(s)
- Sung-Hua Chuang
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Guettrot-Imbert G, Boyer L, Piette JC, Delèvaux I, André M, Aumaître O. [Mesenteric panniculitis]. Rev Med Interne 2012; 33:621-7. [PMID: 22658529 DOI: 10.1016/j.revmed.2012.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 04/15/2012] [Indexed: 12/17/2022]
Abstract
Mesenteric panniculitis is a nonspecific inflammatory process affecting the fatty tissue at the root of the mesentery. This term is also used to describe the clinical and imaging findings in this disorder. Mesenteric panniculitis can be a misleading term: it is commonly misused to design an increased density of the mesentery without prejudice regarding the etiology. Pain is the main clinical symptom. Half of the patients are asymptomatic. There is a palpable mass in half of cases. Laboratory tests sometimes reveal an acute phase reaction of varying intensity. Mesenteric panniculitis is suspected when CT scan shows increased density of the mesenteric fat. Nevertheless, only histological examination could establish the diagnosis. Histologic examination may reveal various stages: lipodystrophy (the first stage when fat necrosis is predominant), mesenteric panniculitis (a majority of infiltrating lymphocytes), sclerosing mesenteritis (the end stage when fibrosis is predominant). Histopathologic differential diagnoses are lymphomas, lipomas, liposarcomas that can mimic mesenteric panniculitis on CT scan. Mesenteric panniculitis is associated with various diseases, especially with intra-abdominal inflammatory process. It also can be idiopathic. Rare complications can occur with vascular or digestive tract compressions. Empirical treatment is only useful in symptomatic patients. Colchicine, corticosteroids or immunosuppressive agents can be used. The only interest of surgery is the histological confirmation of the diagnosis. A better understanding of the pathophysiology of the immunoregulatory functions of adipose tissue will improve mesenteric panniculitis management.
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Affiliation(s)
- G Guettrot-Imbert
- Service de médecine interne, CHU de Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand cedex 1, France.
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Tannoury JN, Abboud BN. Idiopathic sclerosing encapsulating peritonitis: Abdominal cocoon. World J Gastroenterol 2012; 18:1999-2004. [PMID: 22563185 PMCID: PMC3342596 DOI: 10.3748/wjg.v18.i17.1999] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 02/20/2012] [Accepted: 02/26/2012] [Indexed: 02/06/2023] Open
Abstract
Abdominal cocoon, the idiopathic form of sclerosing encapsulating peritonitis, is a rare condition of unknown etiology that results in an intestinal obstruction due to total or partial encapsulation of the small bowel by a fibrocollagenous membrane. Preoperative diagnosis requires a high index of clinical suspicion. The early clinical features are nonspecific, are often not recognized and it is difficult to make a definite pre-operative diagnosis. Clinical suspicion may be generated by the recurrent episodes of small intestinal obstruction combined with relevant imaging findings and lack of other plausible etiologies. The radiological diagnosis of abdominal cocoon may now be confidently made on computed tomography scan. Surgery is important in the management of this disease. Careful dissection and excision of the thick sac with the release of the small intestine leads to complete recovery in the vast majority of cases.
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29
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Da Luz MMP, Barral SM, Barral CM, Bechara CDS, Lacerda-Filho A. Idiopathic encapsulating peritonitis: report of two cases. Surg Today 2011; 41:1644-8. [PMID: 21969199 DOI: 10.1007/s00595-010-4493-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 12/26/2010] [Indexed: 12/18/2022]
Abstract
This report presents two cases of young males who developed the rare idiopathic form of sclerosing encapsulating peritonitis (SEP) presented as partial bowel obstruction, both diagnosed during surgical treatment, with satisfactory outcomes. Sclerosing encapsulating peritonitis is a rare and enigmatic condition, characterized by intraperitoneal fibrosclerosis, which causes intestinal obstruction. It is a chronic entity with a poorly elucidated pathophysiology, leading to the constitution of a thick white nacreous fibrosis membrane that wraps the bowel in a concertina-like fashion with some adhesions configuring an intra-abdominal cocoon. Sclerosing encapsulating peritonitis is reported in a wide variety of patients, including those who have undergone peritoneal dialysis, young adolescent girls, cirrhotic patients after peritoneal-venous shunting, and patients treated with β-blockers. Nevertheless, the etiology of SEP remains obscure. This entity presents many difficulties in preoperative diagnosis because of its peculiar characteristics. Recognition of the SEP results in proper management and prevents unnecessary bowel resection. Regardless of cause, the treatment of the obstruction is surgical, 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 surgical therapy is good, but depends on coexisting diseases.
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Affiliation(s)
- Magda Maria Profeta Da Luz
- Division of Coloproctology and Small Bowel, Alfa Institute of Gastroenterology, Federal University of Minas Gerais Hospital, Av. Alfredo Balena 110 - 2° andar, Belo Horizonte, MG 30130-100, Brazil
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30
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Tan R, Betjes M, Cransberg K. Post-transplantation encapsulating peritoneal sclerosis in a young child. Nephrol Dial Transplant 2011; 26:3822-4. [PMID: 21821834 DOI: 10.1093/ndt/gfr435] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a very rare condition in children. Nevertheless, EPS should be considered when a child with a history of peritoneal dialysis (PD) presents with signs of bowel obstruction. We describe a child with post-transplantation EPS and discuss risk factors, diagnosis and treatment options. CT scan should be performed promptly to confirm the diagnosis. Treatment consists of cessation of the PD, if applicable, and adequate nutrition, either parenteral or enteral. Further medical therapy remains controversial but may involve steroids and/or interruption of calcineurin inhibitors.
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Affiliation(s)
- Ratna Tan
- Department of Children Nephrology, Sophia Children’s Hospital, Erasmus MC, Rotterdam, Netherlands
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31
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Fossey SJ, Simson JNL. Sclerosing encapsulating peritonitis secondary to dermoid cyst rupture: a case report. Ann R Coll Surg Engl 2011; 93:e39-40. [PMID: 21943446 PMCID: PMC5827212 DOI: 10.1308/147870811x582495] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2011] [Indexed: 12/18/2022] Open
Abstract
This case report documents the presentation and management of a 26-year-old female patient diagnosed with SEP secondary to dermoid cyst rupture. The authors postulate that acute chemical peritonitis secondary to dermoid cyst rupture can develop into SEP resulting in the clinical features depicted in this case report.
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Affiliation(s)
- SJ Fossey
- St Richard’s Hospital, Chichester, West Sussex, UK
| | - JNL Simson
- St Richard’s Hospital, Chichester, West Sussex, UK
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32
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Vlijm A, van Schuppen J, Lamers ABGN, Struijk DG, Krediet RT. Imaging in encapsulating peritoneal sclerosis. NDT Plus 2011; 4:281-4. [PMID: 25984169 PMCID: PMC4421726 DOI: 10.1093/ndtplus/sfr068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 05/05/2011] [Indexed: 11/26/2022] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare but very severe complication of long-term peritoneal dialysis (PD). Since the first reports on this disease in the eighties, several imaging techniques have been used for its diagnosis. Because of the rarity of this condition, uniformity in modality and protocols for abdominal imaging for diagnosis has been lacking overtime. Nowadays, computed tomography (CT) is most often used. In this review, we provide an overview of all imaging modalities that have been used overtime to diagnose EPS as a late complication of PD. Imaging features characteristic for EPS and advantages as well as shortcomings of all modalities are discussed. We believe that when EPS is suspected, CT with contrast enhancement should be the modality of first choice in clinical practice.
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Affiliation(s)
- Anniek Vlijm
- Division of Nephrology, Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost van Schuppen
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Dirk G Struijk
- Division of Nephrology, Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ; Dianet Foundation, Utrecht-Amsterdam, The Netherlands
| | - Raymond T Krediet
- Division of Nephrology, Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Adamidis KN, Zachariou CA, Kopaka ME, Charitaki EE, Drakopoulos V, Kara P, Drakopoulos S, Apostolou T. Sclerosing peritonitis presenting 2 years after renal transplantation in a former CAPD patient. Ren Fail 2011; 33:246-8. [PMID: 21332349 DOI: 10.3109/0886022x.2011.552147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sclerosing peritonitis (SP) is a rare but serious complication of peritoneal dialysis (PD), characterized by a fibrous peritoneal thickening. The etiology of this condition remains unknown but is likely to be multifactorial. Patients with SP almost invariably develop ultrafiltration and clearance failure. Although a number of pharmacologic drug treatment options have been tried with various results, surgical treatment and cessation of PD are almost always necessary and transfer to hemodialysis is the only practical option. Despite some evidence supporting the recovery of gastrointestinal function after renal transplantation in such patients, SP may very rarely appear much later after the cessation of PD and even after renal transplantation. We report an interesting case of a former PD patient who 2 years after renal transplantation presented with abdominal discomfort, vomiting, and malnutrition due to SP. Despite the initial conservative treatment, the symptoms persisted and a surgical treatment was decided upon. After that the patient recovered with no further complications. Although the appearance of SP after renal transplantation is extremely rare, it must be included in the differential diagnosis of every case of unexplained malnutrition and abdominal obstruction in a patient with a PD history.
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Térébus Loock M, Lubrano J, Courivaud C, Bresson Vautrin C, Kastler B, Delabrousse E. CT in predicting abdominal cocoon in patients on peritoneal dialysis. Clin Radiol 2010; 65:924-9. [PMID: 20933648 DOI: 10.1016/j.crad.2010.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 06/03/2010] [Accepted: 06/10/2010] [Indexed: 12/12/2022]
Abstract
AIM To evaluate the computed tomography (CT) signs of encapsulating peritoneal sclerosis (EPS) in patients on peritoneal dialysis (PD) as predictive factors for the evolution to abdominal cocoon (AC). MATERIALS AND METHODS Clinical features and CT signs of 90 patients on PD were retrospectively reviewed. According to the clinical features, they were divided into three groups (asymptomatic, moderate, or severe). Clinical results were correlated with previously reported CT signs of EPS, i.e., peritoneal thickening, peritoneal calcifications, loculated fluids, small bowel faeces sign, small bowel obstruction, clustered bowel loops, pseudo sac, signs of bowel ischaemia or necrosis. AC was defined at CT by the association of clustered bowel loops and a pseudo sac. Statistical analysis was performed using the Fisher's exact test and the t-test. RESULTS Although demonstrated in symptomatic patients (p=0.041), the occurrence of AC was not correlated with the severity of the symptoms (p=0.16). Among the CT signs, the presence of loculated fluids (p=0.011), a small bowel faeces sign (p=0.002); and small bowel obstruction (p=0.0001) were found to be statistically correlated with the appearance of an AC. Moreover, the association of loculated fluids, small bowel faeces sign, small bowel obstruction was extremely sensitive and specific in the development of AC (sensitivity=67%, specifity=100%, positive predictive value=100%, negative predictive value=96%). CONCLUSION CT should be carried out in every symptomatic patient on PD. Indeed, the association of loculated fluid, small bowel faeces sign, and small bowel obstruction enables the prediction of the development of AC, which is likely to curtail PD and require surgery.
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Imaging features of encapsulating peritoneal sclerosis in continuous ambulatory peritoneal dialysis patients. AJR Am J Roentgenol 2010; 195:W50-4. [PMID: 20566781 DOI: 10.2214/ajr.09.3175] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this article is to present the spectrum of radiologic findings of encapsulating peritoneal sclerosis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). CONCLUSION Although a rare diagnosis, encapsulating peritoneal sclerosis in patients undergoing CAPD has a high morbidity and mortality. Diagnosis is often delayed because clinical features are insidious and nonspecific. Radiologic imaging may be helpful in the early diagnosis of encapsulating peritoneal sclerosis and in facilitating timely intervention for CAPD patients with encapsulating peritoneal sclerosis.
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Sampimon DE, Korte MR, Barreto DL, Vlijm A, de Waart R, Struijk DG, Krediet RT. Early Diagnostic Markers for Encapsulating Peritoneal Sclerosis: A Case-Control Study. Perit Dial Int 2010; 30:163-9. [DOI: 10.3747/pdi.2009.00022] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Encapsulating peritoneal sclerosis (EPS) is a severe complication of long-term peritoneal dialysis (PD). The aim of this study was to investigate whether dialysate levels of cancer antigen-125 (CA125), K+, interleukin (IL)-6, and vascular endothelial growth factor (VEGF) are early diagnostic markers of EPS. Therefore, we analyzed the time courses of the above described dialysate markers in EPS patients and controls. Methods Dialysate and serum samples of 11 EPS patients and 31 control patients, all treated with PD for at least 57 months, were longitudinally collected during standard peritoneal permeability analyses. CA125 and IL-6 were measured in dialysate only, K+ and VEGF were measured in both dialysate and serum. CA125 and IL-6 are expressed as appearance rates (AR). The linear mixed model was used to analyze the time courses. Sensitivity and specificity were calculated based on the results of the last 2 time points. Results No differences in the time courses of the different markers were present between the groups. For K+ and VEGF attributed to local production, no differences between the groups were found. However, AR-CA125 was lower during the last 3 years prior to EPS ( p < 0.05) and AR-IL-6 tended to be higher 2 years prior to EPS ( p = 0.09). The combination of AR-CA125 < 33 U/min and AR-IL-6 > 350 pg/min had a sensitivity of 70% and a specificity of 89% for the development of EPS. Conclusions Compared to controls, AR-CA125 showed lower values and AR-IL-6 tended to be higher during the last years prior to the diagnosis of EPS. The sensitivity and specificity of the combination of CA125 and IL-6 indicate their potential use for an early diagnosis of EPS.
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Affiliation(s)
| | - Mario R. Korte
- Department of Medicine, Academic Medical Center, University of Amsterdam; Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht
| | | | - Anniek Vlijm
- Division of Nephrology, Albert Schweitzer Hospital, Dordrecht
| | - Rudy de Waart
- Department of Experimental Hepatology, Amsterdam–Utrecht, The Netherlands
| | - Dirk G. Struijk
- Division of Nephrology, Albert Schweitzer Hospital, Dordrecht
- Academic Medical Center, University of Amsterdam; Dianet Foundation, Amsterdam–Utrecht, The Netherlands
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Abstract
OBJECTIVE abdominal cocoon is characterized by total or partial encasement of the small bowel by a thick fibrotic membrane, leading to mechanical obstruction. Here, we report two cases of abdominal cocoon; both patients presented with symptoms of intestinal obstruction. CONCLUSION We describe the CT and sonographic features of this disease, emphasizing the role of MDCT, and discuss the preoperative diagnostic clues.
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Yang W, Ding J, Jin X, Wu H, Kuang J, Tao Z, Chu PG, Yen Y, Qiu W. The plication and splinting procedure for idiopathic sclerosing encapsulating peritonitis. J INVEST SURG 2010; 22:286-91. [PMID: 19842905 DOI: 10.1080/08941930903040072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Idiopathic sclerosing encapsulating peritonitis (ISEP) is a rare cause of small intestinal obstruction. Histologically, ISEP is characterized by a thick fibrotic membrane encasing the small bowel without any apparent pathophysiological factors. While ISEP is predominantly present congenitally in female adolescents from subtropical region, it has been identified throughout the world. Evidence-based effective diagnostics and treatments are pitifully thin. We experienced six cases, four males and two females, which exhibited symptoms in their later thirties and forties. Five patients presented with acute and subacute intestinal obstruction, and one patient with cryptorchidism and seminoma was referred. Due to the limitation in distention and motility of bowel loops of ISEP, imaging exams may not be very reliable for accurate diagnosis and estimation of obstruction progress. They were successfully treated with the mesenteric plication and intraluminal splinting procedures. Two cases had an uneventful postoperative period, and the returns of normal bowel function were delayed in the other four patients. Two recurrences of small bowel obstructions were noted over a mean follow-up period of 33 months with mild symptoms. This article reviews the patterns of clinical presentations, diagnostic clues, and theories of potential risk factors of ISEP as well as its controversial surgical managements.
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Affiliation(s)
- Weiping Yang
- Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Kalra S, Atia A, McKinney J, Borthwick TR, Smalligan RD. Sclerosing encapsulating peritonitis associated with propranolol usage: a case report and review of the literature. J Dig Dis 2009; 10:332-5. [PMID: 19906115 DOI: 10.1111/j.1751-2980.2009.00405.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Sumit Kalra
- Department of Internal Medicine, James H. Quillen VA Medical Center, Johnson City, Mountain Home, Tennessee 37684, USA.
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Hsu YH, Hsia CC, Tsai DM, Tu HY, Hung KY, Huang JW. Development of encapsulating peritoneal sclerosis following bacterial peritonitis in a peritoneal dialysis patient. Am J Kidney Dis 2009; 55:198-202. [PMID: 19782452 DOI: 10.1053/j.ajkd.2009.06.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 06/22/2009] [Indexed: 12/11/2022]
Affiliation(s)
- Yung-Hsuen Hsu
- Department of Nephrology, Taipei City Hospital, Jen-Ai Branch, Taipei, Taiwan, ROC
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Vlijm A, Stoker J, Bipat S, Spijkerboer AM, Phoa SS, Maes R, Struijk DG, Krediet RT. Computed Tomographic Findings Characteristic for Encapsulating Peritoneal Sclerosis: A Case-Control Study. Perit Dial Int 2009. [DOI: 10.1177/089686080902900508] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Computed tomography (CT) is often used to confirm the diagnosis of encapsulating peritoneal sclerosis (EPS) but there is no consensus on specific CT abnormalities. To establish CT findings characteristic for EPS, we compared CT findings between EPS patients and long-term peritoneal dialysis (PD) patients without EPS. Methods We included as cases all EPS patients in our center from 1996 to 2008 that underwent a CT scan at the time of diagnosis. Controls were all other long-term PD patients (PD duration ≥ 4 years) without EPS that had a CT scan for different reasons. The CT scans were blindly and independently reviewed by 3 radiologists: 2 abdominal radiologists with PD knowledge (Observers 1 and 2) and 1 radiologist without PD experience (Observer 3). Results We included 15 EPS patients and 16 controls. Observer 1 found 6 CT findings that were significantly more often present in EPS than in controls ( p ≤ 0.05): peritoneal enhancement, thickening, and calcifications; adhesions of bowel loops; signs of obstruction; and fluid loculation/septation. Observer 2 scored almost identically but Observer 3 scored differently. The sensitivity and specificity of a combination of specific CT findings were, respectively, 100% and 94% for Observers 1 and 2, and 79% and 88% for Observer 3. Conclusion CT scans showed characteristic abnormalities that were significantly more often present in EPS patients compared to long-term PD control patients. CT can be used to confirm the diagnosis of EPS when experienced radiologists apply a combination of specific CT findings.
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Affiliation(s)
| | - Jaap Stoker
- Department of Medicine, and Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam
| | - Shandra Bipat
- Department of Medicine, and Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam
| | - Anje M. Spijkerboer
- Department of Medicine, and Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam
| | - Saffire S.K.S. Phoa
- Department of Medicine, and Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam
| | - Robbert Maes
- Department of Radiology, Gemini Hospital, Den Helder
| | - Dirk G. Struijk
- Division of Nephrology, The Netherlands
- Dianet Foundation, Utrecht–Amsterdam, The Netherlands
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Levy AD, Shaw JC, Sobin LH. Secondary tumors and tumorlike lesions of the peritoneal cavity: imaging features with pathologic correlation. Radiographics 2009; 29:347-73. [PMID: 19325052 DOI: 10.1148/rg.292085189] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Tumors and tumorlike lesions that secondarily involve the mesothelial or submesothelial layers of the peritoneum are a diverse group of disorders that range in biologic behavior from benign to highly malignant. The anatomy of peritoneal ligaments and mesenteries and the normal circulation of peritoneal fluid dictate location and distribution of these diseases within the peritoneal cavity. Peritoneal carcinomatosis is the most common secondary tumor to affect the peritoneal cavity. When it arises from carcinomas of the gastrointestinal tract or ovary, the prognosis is grave. However, when low-grade mucinous adenocarcinoma of the appendix spreads to the peritoneal cavity, the consequence is typically pseudomyxoma peritonei, which is a clinical syndrome, characterized by recurrent and recalcitrant voluminous mucinous ascites due to surface growth on the peritoneum without significant invasion of underlying tissues. Carcinomas from elsewhere in the body, as well as lymphomas and sarcomas, may also produce diffuse peritoneal metastasis. Granulomatous peritonitis is the consequence of disseminated infection such as tuberculosis or histoplasmosis, foreign materials, or rupture of a tumor or hollow viscus. Finally, a group of benign miscellaneous conditions that range from common disorders such as endometriosis and splenosis to very rare conditions such as gliomatosis peritonei and melanosis may also affect the peritoneum diffusely. Secondary tumors and tumorlike lesions of the peritoneum have overlapping imaging features when compared with each other and primary peritoneal tumors. Knowledge of peritoneal anatomy, normal fluid circulation within the peritoneal cavity, and clinical and pathologic features of secondary peritoneal lesions is essential for identification of these lesions.
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Affiliation(s)
- Angela D Levy
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799, USA.
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Stuart S, Booth TC, Cash CJC, Hameeduddin A, Goode JA, Harvey C, Malhotra A. Complications of Continuous Ambulatory Peritoneal Dialysis. Radiographics 2009; 29:441-60. [DOI: 10.1148/rg.292085136] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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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.
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Affiliation(s)
- Roberto Tarquini
- Department of Internal Medicine, University of Florence, Azienda Ospedaliero-Universitaria Careggi. Viale Morgagni 85, Florence 50134, Italy
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Tarzi RM, Lim A, Moser S, Ahmad S, George A, Balasubramaniam G, Clutterbuck EJ, Gedroyc W, Brown EA. Assessing the validity of an abdominal CT scoring system in the diagnosis of encapsulating peritoneal sclerosis. Clin J Am Soc Nephrol 2008; 3:1702-10. [PMID: 18667742 DOI: 10.2215/cjn.01820408] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Encapsulating peritoneal sclerosis (EPS) is a severe peritoneal fibrotic reaction in patients on long-term peritoneal dialysis (PD). The early clinical features may be nonspecific. The purpose of the study is to assess the reliability and diagnostic utility of abdominal CT scanning in the diagnosis of EPS. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Abdominopelvic CT scans of 27 patients diagnosed with EPS on clinical and radiologic grounds in our unit from 1997 to 2006 were retrospectively analyzed. In addition, 35 control CT scans were scored: 15 from hemodialysis patients (HD controls) and 20 from patients on PD (PD controls). Scans were anonymized and scored independently by three radiologists. RESULTS Inter-rater agreement was moderate to very good (kappa = 0.40 to 0.75) for peritoneal calcification, bowel distribution, bowel wall thickening, and bowel dilation but poorer for loculation of ascites and peritoneal thickening. There was a strongly significant difference between the total CT scan scores at EPS diagnosis and controls (P < 0.00001). Each individual parameter also showed significant differences between EPS and controls (P < 0.006). Bowel tethering and peritoneal calcification were the most specific parameters, and. loculation was the least discriminatory parameter. Interestingly, prediagnostic scans a median of 1.5 yr before EPS diagnosis were normal or near-normal in 9 of 13 EPS patients. CONCLUSIONS CT scanning is a valid and reliable adjunct to the diagnosis of EPS but may not be useful as a screening tool, as the prediagnostic scans did not show abnormalities in many patients who subsequently developed EPS.
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Affiliation(s)
- Ruth M Tarzi
- Imperial College Kidney and Transplant Institute, Hammersmith Hospital, London, UK.
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Affiliation(s)
- Nikos Courcoutsakis
- Department of Radiology and Medical Imaging, University Hospital of Alexandroupolis, Greece.
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