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Pathophysiological Changes to the Peritoneal Membrane during PD-Related Peritonitis: The Role of Mesothelial Cells
Susan Yung,Tak Mao Chan
Mediators of Inflammation , 2012, DOI: 10.1155/2012/484167
Abstract: The success of peritoneal dialysis (PD) is dependent on the structural and functional integrity of the peritoneal membrane. The mesothelium lines the peritoneal membrane and is the first line of defense against chemical and/or bacterial insult. Peritonitis remains a major complication of PD and is a predominant cause of technique failure, morbidity and mortality amongst PD patients. With appropriate antibiotic treatment, peritonitis resolves without further complications, but in some PD patients excessive peritoneal inflammatory responses lead to mesothelial cell exfoliation and thickening of the submesothelium, resulting in peritoneal fibrosis and sclerosis. The detrimental changes in the peritoneal membrane structure and function correlate with the number and severity of peritonitis episodes and the need for catheter removal. There is evidence that despite clinical resolution of peritonitis, increased levels of inflammatory and fibrotic mediators may persist in the peritoneal cavity, signifying persistent injury to the mesothelial cells. This review will describe the structural and functional changes that occur in the peritoneal membrane during peritonitis and how mesothelial cells contribute to these changes and respond to infection. The latter part of the review discusses the potential of mesothelial cell transplantation and genetic manipulation in the preservation of the peritoneal membrane.
Sclerosing encapsulating peritonitis  [cached]
Jen-Jung Pan,Nirav Thosani,Michael B. Fallon
Gastroenterology Insights , 2012, DOI: 10.4081/gi.2012.e3
Abstract: Sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction. This entity has been reported as either primary idiopathic or secondary to other diseases. We report SEP in 2 cirrhotic patients and review the literature. Both patients had decompensated cirrhosis and episodes of spontaneous bacterial peritonitis. One patient underwent a Denver shunt placement before developing SEP. This patient remains alive and is managed conservatively. The other patient deceased from multi-organ failure after the resection of gangrened small bowel. The manifestations of SEP are often nonspecific that leads to misdiagnosis and/or delayed diagnosis. Early diagnosis of SEP is difficult but not impossible. Surgical treatment is often required when intestinal obstruction is present. Nevertheless, patients with this problem can be treated conservatively with immunosuppressive therapy with or without total parenteral nutrition (TPN) before going for surgery.
Sclerosing encapsulating peritonitis; silent danger in continuous ambulatory peritoneal dialysis patients: case report and review of the literature
Gürsel Y?ld?z,Abdulkerim Y?lmaz,?brahim ?ztoprak,Ferhan Candan
Cumhuriyet Medical Journal , 2013,
Abstract: Sclerosing encapsulating peritonitis is a rare complication of continuous ambulatory peritoneal dialysis. Sclerosing encapsulating peritonitis causes weight loss, intermittent bowel obstruction and decrease in peritoneal water and solute transport. Mortality may reach up to 50% due to severe malnutrition and ileus. Although the etiology is not fully known, many reasons such as frequent peritonitis attacks, bio-incompatibility of dialysate and catheter, intra-peritoneal contamination with clorhexidine, and use of beta-blockers are held responsible. Diagnosis is difficult in early stage. In this stage, abdominal computed tomography findings are important. It is often diagnosed during operation of the patients who developed complications such as bowel obstruction. Termination of peritoneal dialysis and providing nutritional support, use of immunosuppressive drugs, and surgical approach can be used for treatment. In this article, a 46-year-old male who had been using continuous ambulatory peritoneal dialysis as a renal replacement therapy for 9 years, presenting with peritonitis attacks, severe abdominal pain together with weight loss and was diagnosed as sclerosing encapsulating peritonitis is presented.
Idiopathic sclerosing encapsulating peritonitis (or abdominal cocoon)
Costas Serafimidis, Ioannis Katsarolis, Spyros Vernadakis, George Rallis, George Giannopoulos, Nikolaos Legakis, George Peros
BMC Surgery , 2006, DOI: 10.1186/1471-2482-6-3
Abstract: A 56 year-old man presented in A&E department with small bowel ileus. He had a history of 6 similar episodes of small bowel obstruction in the past 4 years, which resolved with conservative treatment. Pre-operative work-up did not reveal any specific etiology. At laparotomy, a fibrous capsule was revealed, in which small bowel loops were encased, with the presence of interloop adhesions. A diagnosis of abdominal cocoon was established and extensive adhesiolysis was performed. The patient had an uneventful recovery and follow-up.Idiopathic sclerosing encapsulating peritonitis, although rare, may be the cause of a common surgical emergency such as small bowel ileus, especially in cases with attacks of non-strangulating obstruction in the same individual. A high index of clinical suspicion may be generated by the recurrent character of small bowel ileus combined with relevant imaging findings and lack of other plausible etiologies. Clinicians must rigorously pursue a preoperative diagnosis, as it may prevent a "surprise" upon laparotomy and result in proper management.Sclerosing encapsulating peritonitis is a rare cause of small bowel obstruction, and can be classified as idiopathic or secondary (most importantly and most frequently due to chronic ambulatory peritoneal dialysis). The idiopathic form (also known as abdominal cocoon) was first described by Foo et al in 1978[1,2]. It affects mainly young females from tropical and subtropical regions, but adult case reports from temperate zones can be encountered in literature. It is characterized by a thick, fibrotic, cocoon-like membrane, partially or totally encasing the small bowel. Clinically, it presents with recurrent episodes of acute or subacute small bowel obstruction, weight loss, nausea and anorexia, and at times with a palpable abdominal mass[2]. Most cases are diagnosed incidentally at laparotomy, as in the case presented, although a preoperative diagnosis is purported feasible by a combination of barium foll
Sclerosing encapsulating peritonitis - mesenteritis. A case report  [cached]
Lorentziadis M.L.,Poulantzas I.K.
Annals of Gastroenterology , 2007,
Abstract: SUMMARY Sclerosing encapsulating peritonitis is a rare condition of unknown cause with reported high mortality and mobidity. It is treated surgically and it is difficult to diagnose preoperatively since it has no specific imaging findings. We present a case report of idiopathic sclerosing encapsulating peritonitis-mesenteritis with a literature review on this pathologic entity. Sclerosing encapsulating peritonitis-mesenteritis is an intestinal wall lesion which causes obstructive bowel symptoms. The idiopathic expression of the disease is a rare entity which is treated surgically as there are several operative options. The management of the sclerosing encapsulating peritonitis-mesenteritis is followed by a complication rate of 38%-90% and a mortality rate of 60%-71%.1 Key words: Sclerosing peritonitis, mesenteritis, encapsulating peritonitis
Idiopathic sclerosing encapsulating peritonitis: an uncommon cause of intestinal obstruction  [cached]
José de Arimatéia Batista Araújo Filho,Jo?o Augusto Santos Martines,Brenda Margatho Ramos Martines,Adriano Ferreira Silva
Autopsy and Case Reports , 2012,
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-yearold 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.
Idiopathic sclerosing encapsulating peritonitis: Abdominal cocoon  [cached]
Jenny N Tannoury,Bassam N Abboud
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i17.1999
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.
Encapsulating peritoenal sclerosis: Case report  [PDF]
?uri? Petar,Majster Zdenka,Stankovi?-Popovi? Verica,Maslarevi?-Radovi? Vesna
Medicinski Pregled , 2013, DOI: 10.2298/mpns1304185d
Abstract: Introduction. Encapsulating peritoneal sclerosis is a possible, serious, life-threatening complication of peritoneal dialysis therapy. Case 1. A female patient was hospitalized for clinical signs of encapsulating peritoneal sclerosis in the inflammatory stage with fever, intestinal occlusion, positive inflammatory syndrome (Le 20 K/μL, CRP 217 mg/L) and highly turbid peritoneal effluent (Le 3.3 K/μL) with sterile culture. Risk factors for the development of encapsulating peritoneal sclerosis were nine previous episodes of peritonitis and long-term use of high osmolality dialysis solution. The diagnosis was confirmed by computed tomography findings. During the course of therapy, the patient had a good response to Tamoxifen and prednisone. Although encapsulating peritoneal sclerosis was well controlled, the patient died after eight months due to tuberculosis of the lungs with signs of heart failure. Case 2. The clinical presentation also corresponded to encapsulating peritoneal sclerosis in the inflammation stage, and the identified risk factors were the long-term treatment with peritoneal dialysis (100 months) and an episode of peritonitis with tunnel infection. The first sign of encapsulating peritoneal sclerosis was hemorrhagic ascites, which was observed when the peritoneal catheter was being replaced. The diagnosis was confirmed by computed tomography findings. He was treated with Tamoxifen (10 mg 2x2 tbl). Except anemia, poor appetite and fatigue, the patient denied any other symptoms after 14 months of therapy. Conclusion. During peritoneal dialysis, one should always think about encapsulating peritoneal sclerosis which is not always easy to recognize. Timely diagnosis with the use of corticosteroids and Tamoxifen in the first and Tamoxifen in the second case were effective in controlling and preventing disease progression.
Peritonite esclerosante encapsulante pós-diálise peritoneal Sclerosing encapsulating peritonitis after peritoneal dialysis
Alexandre Tagliari Cestari,Marina Louren?o de Conti,Jo?o Antonio Gon?alves Garreta Prats,Henri Sato Junior
Jornal Brasileiro de Nefrologia , 2013,
Abstract: Pacientes com insuficiência renal cr nica terminal em uso de diálise peritoneal (DP) est o sujeitos a diversas complica es da própria terapia de substitui o renal. Relatamos uma complica o rara da DP na qual o perit neo, após anos de contato com a substancia hipert nica dialisante, é gradualmente substituído por tecido fibroso. O paciente em quest o teve diversas intercorrências após o início da DP, incluindo uma peritonite bacteriana, hiperparatireoidismo terciário (sendo tratado com duas paratireoidectomias) e colelitíase (sendo tratado com colecistectomia videolaparoscópica). Após 8 anos de diálise peritoneal, foi transferido para hemodiálise por diminui o da ultrafiltra o e episódios de suboclus o intestinal, sendo diagnosticado como peritonite esclerosante encapsulante (PEE). Atualmente, está em corticoterapia e com diminui o significativa dos sintomas e provável estabiliza o da PEE. Patients with chronic renal failure in use of peritoneal dialysis (PD) are subject to various complications of the renal replacement therapy. We report a rare complication of PD in which the peritoneum, after years of contact with hypertonic dialysate, is gradually replaced by fibrous tissue. This patient had several complications after initiation of PD including a bacterial peritonitis, tertiary hyperparathyroidism (being treated with parathyroidectomy 2) and cholelithiasis (being treated with laparoscopic cholecystectomy). After 8 years of peritoneal dialysis was transferred to hemodialysis by decreasing ultrafiltration and episodes of intestinal sub-occlusion, being diagnosed as sclerosing encapsulating peritonitis (SEP). He is currently on corticotherapy with a significant reduction of symptoms and likely stabilization of the SEP.
Abdominal Cocoon Syndrome (Idiopathic Sclerosing Encapsulating Peritonitis): How Easy Is Its Diagnosis Preoperatively? A Case Report  [PDF]
Julius A. A. Awe
Case Reports in Surgery , 2013, DOI: 10.1155/2013/604061
Abstract: The abdominal cocoon syndrome (or idiopathic encapsulating peritonitis) is a rare cause of intestinal obstruction. It has been reported predominantly in adolescent girls living in tropical/subtropical region in which diagnosis is only made at laparotomy in most cases. The cause and pathogenesis of the condition have not been elucidated. Prolonged administration of practalol, meconium peritonitis, and tuberculous infection of the female genital tract have been incriminated as possible causes. The author reports a case of a female patient with recurrent intestinal obstruction treated for years but failed to settle down on conservative treatment during her last hospital admission and had to undergo surgery. Preoperative diagnosis of this syndrome as the cause of her intestinal obstruction was not made until at laparotomy, when a thick fibrotic peritoneal wrapping of the bowel in a concertina-like fashion with some adhesions was found. Excision of this membrane and adhesiolysis were carried out without any need for bowel resection, and this led to relief of the obstruction and patient’s complete recovery. Awareness of this benign condition in the differential diagnosis of intestinal obstruction will result in early diagnosis and correct management and prevent unnecessary bowel resections and bad outcomes. 1. Introduction Abdominal cocoon syndrome (or idiopathic encapsulating peritonitis) is a relatively rare cause of intestinal obstruction, described mostly in young adolescent girls, and was first described in 1978 [1]. The etiology of this disease is largely unknown and the cases seen so far have been limited to the tropical and subtropical zones and primarily affect young adolescent females, even though several earlier cases have been reported also in males [2, 3]. Thick fibrotic peritoneum encasing the small bowel partially or completely is a pathognomonic feature, and the correct diagnosis is not often made preoperatively. This is the case report of an eighteen- (18-) year-old Nigerian girl that presented with intestinal obstruction [4] that failed to settle down on conservative treatment during her last hospital admission and had to undergo surgery. The author is therefore presenting the case so that practicing surgeons have better awareness of this condition as a possible cause in the differential diagnosis of intestinal obstruction which may facilitate pre-operative diagnosis, prevent inadvertent bowel damage at laparoscopy, and prevent unnecessary bowel resection at laparotomy [5]. 2. Case Report An eighteen- (18-) year-old Nigerian girl presented
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