Idiopathic-abdominal-cocoon—a-rare-cause-of-small-bowel-obstruction

The idiopathic form of sclerosing encapsulating peritonitis, also known as abdominal cocoon, is a rare entity of unknown cause that leads to intestinal obstruction due to complete or partial encapsulation of the small intestine by a fibro- collagenous membrane. As the initial clinical features are non-specific, they often remain unrecognized making it difficult to make a definite pre-operative diagnosis. Recurrent episodes of small intestinal obstruction along with relevant imaging findings and lack of other causative mechanisms, gives rise to a clinical suspicion. We report a young lady who presented to us with features suggestive of acute intestinal obstruction. Thorough enquiry revealed similar episodes on multiple occasions in the past which was temporarily relieved with conservative management. The need to keep an open mind regarding the uncommon causes of commonly encountered problems is the point of interest in our case.

Risk factor analysis of hepatocellular carcinoma with vessels encapsulating tumor clusters and the application value of its risk scoring model / 中华消化外科杂志

Objective:To investigate the risk factor of hepatocellular carcinoma (HCC) with vessels encapsulating tumor clusters (VETC) and the application value of its risk scoring model.Methods:The retrospective cross-sectional study was conducted. The clinicopathological data of 149 patients with HCC who were admitted to two medical centers, including 97 cases in the Jiangnan University Medical Center and 52 cases in the Affiliated Xingtai People′s Hospital of Hebei Medical University, from January 2017 to April 2020 were collected. There were 116 males and 33 females, aged (58±12)years. There were 74 cases with VETC and 75 cases without VETC. Observation indica-tors: (1) clinical characteristics of patients with and without VETC; (2) imaging features of patients with and without VETC; (3) multivariable analysis of HCC patients with VETC; (4) construction of VETC related risk scoring model and its performance evaluation; (5) postoperative early tumor recurrence of patients with and without VETC who were confirmed by risk scoring model and histopathological examination. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Count data were described as absolutes, and comparison between groups was conducted using the chi-square test and continuous correction chi-square test. Variables of clinical and imaging characteristics with statistically signifi-cant were included in the multivariate analysis. Multivariate analysis was conducted using the Logistic regression model of backward stepwise selection. VETC related risk scoring model was constructed based on the results of Logistic regression model. The receiver operating characteristic (ROC) curve was drawn, and the area under curve (AUC), the sensitivity, specificity, accuracy and their 95% confidence interval ( CI) were calculated. The maximizing Youden index was the optimal cutoff value for VETC prediction. The Hosmer Lemeshow goodness of fit test was used to assess the consistency between VETC risk scoring model predicted VTEC status and the true VETC status. The Kaplan-Meier method was used to calculate survival rates and draw survival curves. The Log-rank test was used for survival analysis. Results:(1) Clinical characteristics of patients with and without VETC. Cases with postoperative albumin <36 g/L were 57 in patients with VETC, versus 68 in patients without VETC, respectively, showing a significant difference between them ( χ2=5.13, P<0.05). (2) Imaging features of patients with and without VETC. Cases with lesion imaging presence as nonperipheral washout, cases with lesion imaging presence as mosaic architecture, cases with lesion imaging presence as intratumoral hemorrhage, cases with lesion imaging presence as corona enhancement, cases with lesion imaging presence as non-smooth tumor margin, cases with lesion imaging presence as peritumoral enhancement in arterial phase, cases with lesion imaging presence as intratumoral arteries, cases with lesion imaging presence as peritumoral hypointensity in hepatobiliary phase, cases with lesion imaging enhancement type as uniform low enhancement, uniform high enhance-ment, heterogeneous enhancement with septations and heterogeneous enhancement with irregular ring-like structures, cases with intratumoral necrosis or ischemic, cases with tumor diameter >5 cm were 73, 35, 33, 15, 39, 28, 42, 27, 4, 5, 27, 38, 45, 46 in patients with VETC, versus 64, 16, 13, 3, 19, 15, 9, 13, 9, 35, 5, 26, 10, 10 in patients without VETC, respectively, showing significant differences in the above indicators between them ( χ2=8.92, 11.15, 12.97, 9.28, 11.74, 5.77, 33.14, 6.96, 41.79, 36.05, 37.86, P<0.05). (3) Multivariable analysis of patients with VETC. Results of multivariable analysis showed that lesion imaging enhancement as heterogeneous enhancement with septations, lesion imaging enhancement as heterogeneous enhancement with irregular ring-like structures, intratumoral necrosis or ischemia and tumor diameter >5 cm were independent risk factors influen-cing patients with VETC ( odds ratio=4.18, 7.62, 4.23, 4.08, 95% CI as 1.60?11.60, 2.00?31.70, 1.71?10.90, 1.60?10.80), P<0.05). (4) Construction of VETC related risk scoring model and its performance evaluation. The VETC related risk scoring model was constructed as (heterogeneous enhancement with septations, presence: 1.0, absence: 0)+(heterogeneous enhancement with irregular ring-like structures, presence: 1.5, absence: 0)+(intratumoral necrosis or ischemia, presence: 1.0, absence: 0)+(main tumor diameter >5 cm, presence: 1.0, absence: 0). The AUC, sensitivity, specificity, and accuracy of VETC related risk scoring model were 0.86 (95% CI as 0.80?0.92), 79.7% (95% CI as 69.2%?87.3%), 80.0% (95% CI as 69.6%?87.5%) and 79.9% (95% CI as 72.7%?85.5%), respectively. Results of Hosmer-Lemeshow goodness of fit test showed a good consistency between VETC risk scoring model predicted VETC status and true VETC status ( P>0.05). (5) Postoperative early tumor recurrence of patients with and without VETC who were confirmed by risk scoring model and histopathological examination. All 149 patients were followed up for 29(range, 26?35)months. The time to tumor recurrence and 2-year cumulative tumor recurrence rate of 149 patients were 29(range, 24?33)months and 43.0%, respectively. The 2-year tumor cumulative recurrence rate of patients with and without VETC predicted by risk scoring model was 47.8% and 37.9%, respectively, showing a significant difference between ( χ2=3.90, P<0.05). The 2-year cumulative tumor recurrence rate of patients with and without VETC confirmed by postoperative histopathological examination was 47.4% and 38.1%, respectively, showing a significant difference between ( χ2=4.20, P<0.05). Conclusions:Lesion imaging enhancement as heterogeneous enhancement with septations or irregular ring-like structures, intratumoral necrosis or ischemia and tumor diameter >5 cm are independent risk factors influen-cing HCC patients with VETC. The proposed risk scoring model based on those three risk factors achieves an optimal preoperative diagnostic performance.

IgG4 related sclerosing encapsulating peritonitis with cocoon formation: An unusual and undescribed presentation

IgG4-related sclerosing mesenteritis is a rare disease of mesentery of an unknown etiology which shows a constellation of histopathologic findings of lymphoplasmacytic inflammation with IgG4-positive plasma cells and marked fibrosis. This chronic inflammatory condition of mesentery forming an abdominal cocoon has never been described before to the best of our knowledge. Here, we report a patient with a history of subacute small bowel obstruction who was found to have an intra-abdominal encapsulating mass in the right iliac fossa and was finally diagnosed as IgG4-related sclerosing encapsulating peritonitis (abdominal cocoon) based on peroperative findings, histology and immunohistochemistry.

Peritonitis encapsulante esclerosante (síndrome de cocoon): una causa extremadamente rara de obstrucción intestinal. Reporte de un caso y revisión de la literatura / Cocoon syndrome: an extremely rare cause of bowel obstruction. Case report and literature review

La peritonitis esclerosante encapsulante o síndrome de cocoon es una causa rara de obstrucción intestinal, que puede dividirse en pri-maria o secundaria, producida por una membrana fibrocolágena que envuelve el intestino delgado. El diagnóstico es particularmente desafiante, al tratarse de una entidad cuya clínica es inespecífica. El conocimiento de los hallazgos imagenológicos, sumados a una correcta anamnesis, permite una adecuada valoración preoperatoria. Presentamos un caso de interés y de difícil diagnóstico, junto con una revisión de la literatura sobre el tema.

Sclerosing encapsulating peritonitis or cocoon syndrome is a rare cause of intestinal obstruction, that can be divided into primary or secondary. It is produced by a fibro collagenous membrane that surrounds the small bowel. The diagnosis is particularly challenging since it is an entity whose symptoms are nonspecific. Knowledge of the imaging findings, in addition to a well performed anamnesis allows an adequate preoperative assessment. We present a clinical case and a review of the literature.

The effects of tacrolimus and mycophenolate mofetil on regression of encapsulating peritoneal sclerosis in a rat model / Efectos del tacrolimus y el micofenolato mofetil en la regresión de la esclerosis peritoneal encapsulante en ratas

ABSTRACT Objective: Encapsulating peritoneal sclerosis (EPS) is a rare, but potentially fatal complication of peritoneal dialysis. Currently, treatment of peritoneal fibrosis is not fully possible yet. In this study, we aimed to demonstrate the effects of tacrolimus therapy on peritoneal fibrosis and inflammation when administered alone or with mycophenolate mofetil (MMF) in the EPS model induced in rats. Methods: Thirty six Wistar albino rats were separated into six equal groups. Group I was the control group. Group II-VI were administered intraperitoneal chlorhexidine (CH) for induced EPS model in rats. Group II, IV, V, VI were administered isotonic liquid, tacrolimus, tacrolimus and concurrently with CH, tacrolimus and MMF together, respectively. Group III was not administered any drug. All peritoneal samples were stained immunohistochemically with matrix metalloproteinase-2 (MMP-2) antibody. Thickness of peritoneal fibrosis, subserosal large collagen fibers, subserosal fibroblast proliferation and subserosal fibrotic matrix deposition were evaluated. Results: Comparing the experimentally induced EPS groups, the best histopathological results and the largest staining with MMP-2 were achieved in Group VI. Furthermore, in all treatment groups (IV, V, VI) more staining with MMP-2 was detected compared to non-treatment groups (I, II, III) but no statistically significant differences were found among all groups. A statistically significant remission was observed in all histopathological parameters, primarily peritoneal thickness in rats that were administered MMF with tacrolimus, compared to rats which were administered tacrolimus only. Conclusion: Concurrent use of tacrolimus and MMF in the treatment of EPS may be a promising approach.

RESUMEN Objetivos: La esclerosis peritoneal encapsulante (EPE) es una complicación rara, peropotencialmente fatal de la diálisis peritoneal. Actualmente, el tratamiento de la fibrosis peritoneal aún no es posible. En este estudio, apuntamos a demostrar los efectos de la terapia con tacrolimus en la fibrosis peritoneal y la inflamación cuando se administran solos o con micofenolato de mofetilo (MMF) en el modelo EPE inducido en ratas. Métodos: Treinta y seis ratas Wistar albinas se separaron en seis grupos iguales. El Grupo I era el grupo de control. En los grupos II-VI se administró clorhexidina intraperitoneal (CH) para el modelo EPE inducido en ratas. En los Grupos II, IV, V, VI se administró respectivamente líquido isotónico, tacrolimus, tacrolimus y CH y finalmente tacrolimus y MMF juntos. El grupo III no recibió ningún medicamento. Todas las muestras peritoneales se tiñeron inmunohistoquímicamente con el anticuerpo Matrix Metaloproteinasa-2 (MMP- 2). Se evaluó el grosor de la fibrosis peritoneal, se evaluaron las fibras de colágeno grandes subserosas, la proliferación de fibroblastos subserosa y la deposición de la matriz fibrótica subserosa. Resultados: Comparando los grupos de EPE inducidos experimentalmente, los mejores resultados histopatológicos y la tinción con MMP- 2 más extensa se lograron en el Grupo VI. Además, en todos los grupos de tratamiento (IV, V, VI) se detectó más tinción con MMP-2 en comparación con los grupos de no tratamiento (I, II, III), pero no se encontraron diferencias estadísticamente significativas entre todos los grupos. Se observó una remisión estadísticamente significativa en todos los parámetros histopatológicos, principalmente el espesor peritoneal en ratas que recibieron MMF con tacrolimus, en comparación con las ratas que recibieron solo tacrolimus. Conclusión: El uso concurrente de tacrolimus y MMF en el tratamiento de EPS puede ser una aplicación prometedora.

Transition of lymphocyte subsets in peritoneal dialysis effluent and its relationship to peritoneal damage / Journal of Rural Medicine

Objective: Peritoneal function during peritoneal dialysis (PD) declines over time due to peritoneal inflammation; however, the immunological mechanism has not been fully clarified. Here, we examined changes in each cellular fraction in the peritoneal dialysis effluent by flow cytometry and their relationship to peritoneal damage.Patients and Methods: We enrolled 23 patients who began PD between 2006 and 2017 and had available datasets of the peritoneal equilibration test and flow cytometric analysis for at least three consecutive visits, with an interval of six months from six months after introducing PD. The levels and changes in each cellular fraction, dialysate/plasma (D/P) creatinine ratio, and the forward scatter (FSC) ratio of mesothelial cells to lymphocytes were compared using a simple linear regression analysis.Results: Among the examined variables, only the fraction of CD8+ TCM cells during the first observation was significantly correlated with the change rate in the D/P creatinine ratio (β=1.47, P=0.001, adjusted R2=0.379). The CD8+ naïve T and CD8+ TCM cell fractions were negatively correlated with the change rate of the D/P creatinine ratio (naïve T cells: β=−0.058, P=0.022, adjusted R2=0.188; TCM cells: β=−0.096, P=0.046, adjusted R2=0.137). In addition, the change rates of the D/P creatinine ratio tended to be higher, though not significantly (one way ANOVA; P=0.080), in accordance with the increase in the change rate of the CD8+ effector memory T cells (TEM).Conclusion: The CD8+ naïve T and TCM cells may transition into TEM cells by repeated exposure to the dialysate over time. The TEM cells residing in the peritoneum may play a significant role in the progression of peritoneal damage.

Research focus and application advantages in encapsulating biomaterial for islet transplantation / 中国组织工程研究

BACKGROUND: Currently, it was confirmed that encapsulating islets with natural or synthetic biomaterials to form a barrier with the function of immune isolation can not only reduce the systematic use of immunosuppressive agents to a certain extent, but also make heterogenous islet transplantation possible. OBJECTIVE: To introduce the research progress of the biomaterials for islet transplantation, describe several models for encapsulating islet, and eventually discuss current research focus and prospects of islets encapsulating models. METHODS: The authors searched PubMed and Web of Science databases with the search terms “islet encapsulation, islet transplantation biomaterials, islet transplantation hydrogel” for relevant papers published. Initially, a total of 447 papers were retrieved, and 89 of them were included in the final analysis. RESULTS AND CONCLUSION: There are two main deficiencies in islet encapsulation for transplantation: one is the attack of immune rejection by the recipient; the other is the shortage of supply of oxygen and nutrient. Encapsulation of islet with a single material, synthetic or natural biomaterial, cannot address the two issues mentioned above. Herein, the biomaterial used for islet encapsulation must be modified. Current islet hydrogel models tend to combine synthetic biomaterials with natural biomaterials to take full advantage of the two kinds of biomaterials. In addition, immune-regulating drugs, angiogenic factors, or factors promoting the survival or function of islets can also be incorporated into the biomaterial. Besides, other cells can be involved to co-transplant with islets in the hydrogel. How to incorporate various strategies for addressing the above issues properly is the key of future research.

A case of encapsulated peritoneal sclerosis after peritoneal dialysis-related peritonitis / 中南大学学报(医学版)

Encapsulating peritoneal sclerosis (EPS) is a rare but severe complication of peritoneal dialysis. A total of 50% of the patients died within 12 months after being diagnosed. There are no obvious clinical symptoms in the early stage of EPS, which is easy to be missed. And there are few case reports of EPS in early stage. On December 22, 2018, a 70-year-old male patient undergoing peritoneal dialysis for 17 months, who was diagnosed as EPS, was admitted to the Department of Nephrology, the Third Xiangya Hospital, Central South University. The patient's peritoneal dialysis catheter was obstructed after peritonitis. The peritoneal dialysis fluid couldn't be drain in and out of the abdominal cavity. Therefore, the laparoscopy was performed to repair the catheter. The operation in progress showed that the peritoneum was slightly thickened and the ileocecal intestinal tube was closely adhered to the parietal peritoneum where the catheter was wrapped, indicating the early stage of EPS. Peritoneal relaxation was performed. The patient's catheter was normal after adhesiolysis. He underwent hemodialysis, nutritional supporting as well as peritoneal dialysis transition, etc. The peritonitis was controlled after 10 days and the peritoneal dialysis was resumed. After discharge from hospital, the patient took moxifloxacin for 2 more weeks. We followed up the patient for 6 months. The automated peritoneal dialysis is maintained, and everything remains normal. Clinicians need to improve understanding of EPS. Early diagnosis and laparoscopic adhesiolysis is helpful to continue peritoneal dialysis treatment.

Efficacy of alginate- and clay-encapsulated microorganisms on the growth of Araçá-Boi seedlings (Eugenia stipitata)

The present work aimed to evaluate the effects of encapsulated microorganisms on seedlings of Eugenia stipitata, popularly known as araçá-boi, to evaluate the interaction between the inoculum and encapsulating agents such as clay and alginate. The experiment was carried out in a completely randomized design using a 3×2 factorial scheme. The treatments were control, inoculum, clay without microbial inoculum, clay with microbial inoculum, alginate without microbial inoculum, and alginate with microbial inoculum. The seedlings were grown under nursery conditions over a period of 3 months. No treatment increased the height, stem diameter, shoot dry matter or root dry matter of the araçá-boi seedlings. The use of alginate increased the ammonium content compared to the clay and control treatments. Alginate and clay increased the nitrate content in relation to the control. Alginate increased the total number of bacteria in relation to the clay and control treatments. The application of inoculum combined with alginate increased the nitrate content only in relation to the clay and control treatments. Although the application of inoculum promoted an increase in the nitrate content compared to the uninoculated treatments, there was no effect for the other parameters analyzed. The results suggest that clay and alginate encapsulating agents with the presence or absence of microorganisms may improve some soil parameters.

Outcomes of the surgical management of encapsulating peritoneal sclerosis: A case series from a single center in Korea

BACKGROUND: Encapsulating peritoneal sclerosis (EPS) is a rare but near-fatal complication of peritoneal dialysis (PD). Despite the high mortality rate of EPS, the surgical treatment strategy of severe EPS is yet to be established.METHODS: We retrospectively analyzed outcomes of patients with EPS who underwent enterolysis for intractable EPS at Seoul National University Hospital between 2001 and 2018. EPS was diagnosed based on the clinical symptoms and radiological findings of abdominal computed tomography (CT). CT scans were scored according to an EPS scoring system that assessed peritoneal thickening and calcification as well as bowel thickening, tethering, loculation, and dilatation.RESULTS: Thirteen patients (nine males and four females; age, 48 [29–63] years) underwent enterolysis for severe EPS. PD duration (11 [6–21] years) was not associated with survival. Two patients were newly diagnosed with EPS following kidney transplantation. Five patients died of infectious complications immediately after the surgery. Eight patients survived after the first surgery; however, five of them underwent reoperation but died of persistent infection, fistula formation, or adhesive bowel obstruction. Four young (< 60 years) male patients with relatively low CT scan scores (< 13) survived for > 2 years after the first surgery. Median survival duration from EPS diagnosis was 22 (1.3–184) months and that from the first surgery was 9 (0.3–153) months.CONCLUSION: The high mortality rate of EPS suggests the importance of appropriate surgical intervention in young symptomatic male EPS patients with relatively low CT scan scores.

Idiopathic abdominal cocoon: An enigma

Abdominal cocoon is often described by various terminologies like encapsulating peritoneal sclerosis (EPS) or sclerosing encapsulating peritonitis or peritonitis chronica fibrosa incapsulata is defined as syndromes associated with symptoms due to formation of a fibro-collagenous peritoneal membrane involving commonly the small intestinal loop. Clinical presentation ranges from abdominal pain to features of intestinal obstruction which may be acute or sub-acute. It is believed to be mesenchymal transition of mesothelial cells. This condition is commonly associated with tuberculosis, peritoneal dialysis and previous abdominal surgeries but may also be idiopathic. Though a wide range of medical management has been tried for conservative management of the patient, surgery is the preferred choice of treatment to alleviate the persisting symptoms. This is one condition where on table intra op diagnosis supersedes the imaging and histological diagnosis. Here, we discuss the case report of 32 year old male, known diabetic for 4 years, who presented with complaints of abdominal pain, intermittent for over 5 years, with no evidence of intestinal obstruction. Imaging showed abdominal cocoon of small bowel loops and mid gut rotation anomaly with internal hernia. Laparoscopically the cocoon sac was removed and adhesiolysis was done. This case report is to add richness to limited amount literary resources available about abdominal cocoon syndrome.

Obstrucción intestinal por peritonitis esclerosante encapsulada en un adulto con derivación ventriculoperitoneal / Bowel obstruction caused by sclerosing encapsulating peritonitis in adult with ventriculoperitoneal shunt

Resumen Introducción La peritonitis esclerosante encapsulada es una inflamación crónica del peritoneo caracterizada por la formación progresiva de colágeno que produce un engrosamiento peritoneal que encapsula las asas del intestino delgado, produciendo una obstrucción intestinal. Caso clínico Varón de 83 años portador de catéter de derivación ventriculoperitoneal de baja presión desde hacía 8 años. Acude a Urgencias por clínica de obstrucción intestinal, con hallazgos radiológicos en relación con obstrucción de intestino delgado en probable relación con catéter de derivación ventriculoperitoneal, por lo que se decide realizar intervención quirúrgica urgente. Se confirmó la obstrucción intestinal y un cambio de calibre del íleon terminal. El intestino delgado estaba dilatado formando un ovillo, englobado por una pequeña cápsula fibrosa. Se realizó adhesiólisis y hemicolectomía derecha con resección del segmento intestinal afectado. La anatomía patológica fue compatible con peritonitis esclerosante encapsulada. Conclusiones La peritonitis esclerosante encapsulada es una causa poco frecuente y potencialmente grave de obstrucción intestinal y su forma secundaria está habitualmente asociada a la diálisis peritoneal crónica. Su diagnóstico radiológico es difícil y el tratamiento de elección es quirúrgico. Debemos considerarla en casos de obstrucción intestinal en pacientes portadores de derivación ventriculoperitoneal.

Introduction Sclerosing encapsulating peritonitis is a chronic inflammation of the peritoneum characterized by the progressive accumulation of collagen. This leads to a thickening of the peritoneum, encapsulating loops of small bowel and causing intestinal obstruction. Case report 83 year old male, carrying a ventriculoperitoneal low pressure shunt for 8 years. The patient was admitted for emergency surgery after presentation for possible intestinal obstruction with radiological findings consistent with small bowel obstruction, probably related to the catheter of the ventriculoperitoneal shunt. Surgery confirmed bowel obstruction and a change of gauge of the terminal ileum. The small bowel was dilated into a ball, encased by a small fibrous capsule. Adhesiolysis and right hemicolectomy was performed with resection of the affected bowel segment. The pathology was consistent with sclerosing encapsulating peritonitis. Conclusions Sclerosing encapsulating peritonitis is a rare and potentially serious cause of bowel obstruction and its secondary form is usually associated with chronic peritoneal dialysis. The radiological diagnosis is difficult and the treatment of choice is surgical. We must consider it in cases of intestinal obstruction in patients with ventriculoperitoneal shunt.

Unusual intestinal obstruction due to idiopathic sclerosing encapsulating peritonitis: a report of two cases and a review

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.

Idiopathic Sclerosing Encapsulating Peritonitis Revealed by Intestinal Obstruction.

Sclerosing encapsulating peritonitis (SEP) is a very rare entity characterized by encasement of small intestine by a fi­brocollagenous membrane. It is divided into primary (idiopathic) which is named as abdominal cocoon and secondary forms. The preoperative diagnosis is difficult and most cases are diagnosed intraoperatively. A conservative treatment approach is the most suitable management strategy in asymptomatic idiopathic SEP. In this paper, we aimed to present a case of idiopathic SEP revealed by intestinal obstruction.

Sclerosing encapsulating peritonitis: a case report / Peritonite esclerosante encapsulante: relato de caso

Sclerosing encapsulating peritonitis, a rare cause of bowel obstruction, was described as a complication associated with peritoneal dialysis which is much feared because of its severity. The authors report a case where radiological findings in association with clinical symptoms have allowed for a noninvasive diagnosis of sclerosing encapsulating peritonitis, emphasizing the high sensitivity and specificity of computed tomography to demonstrate the characteristic findings of such a condition.

Peritonite esclerosante encapsulante, causa rara de obstrução intestinal, foi descrita como uma complicação associada à diálise peritoneal, muito temida por sua gravidade. Relata-se um caso em que os achados radiológicos associados aos sintomas clínicos permitiram o diagnóstico não invasivo de peritonite esclerosante encapsulante, destacando-se a alta sensibilidade e especificidade da tomografia computadorizada na demonstração dos achados característicos.

A Pre-Operatively Diagnosed Abdominal Cocoon.

Abdominal Cocoon or idiopathic encapsulating peritonitis is a rare cause of intestinal obstruction. It more commonly occurs in young adolescent girls and the diagnosis is usually made at laparotomy. Recent case reports suggest that it is not uncommon in males and pre-operative diagnosis is possible by radiological investigations. We present a case of abdominal cocoon in an adult male, pre-operatively diagnosed by ultrasound and computerized tomography.

Peritonite encapsulante: tomografia computadorizada e correlação cirúrgica / Encapsulating peritonitis: computed tomography and surgical correlation

A peritonite esclerosante encapsulante é uma entidade rara, muitas vezes grave, caracterizada pelo envolvimento total ou parcial de alças do intestino delgado por uma membrana de tecido fibroso. Apresenta quadro clínico inespecífico de obstrução intestinal, exigindo diagnóstico por imagem preciso para orientação do tratamento. O presente relato enfatiza a importância da tomografia computadorizada no diagnóstico desta doença, com confirmação por correlação cirúrgica.

Sclerosing encapsulating peritonitis is a rare and frequently severe entity characterized by total or partial involvement of small bowel loops by a membrane of fibrous tissue. The disease presents with nonspecific clinical features of intestinal obstruction, requiring precise imaging diagnosis to guide the treatment. The present report emphasizes the importance of computed tomography in the diagnosis of this condition and its confirmation by surgical correlation.

A Case of Sclerosing Encapsulating Peritonitis Presented with Systemic Lupus Erythematosus

Sclerosing encapsulating peritonitis (SEP) is characterized by peritoneal fibrosis and adhesion of the peritoneum with the loops of the small intestine. Although the prevalence is low, most cases are caused by peritoneal dialysis, infection, medication, systemic lupus erythematosus (SLE), and intra-abdominal neoplasm. We describe a 22-year old man who was presented with abdominal pain and distension, which were attributed to SLE with peritonitis. He had no specific history of previous medical illness and peritoneal dialysis. He was treated with intravenous high dose methylprednisolone 1 g/day for 3 days, followed by intravenous methylprednisolone 1 mg/kg daily and immunoglobulin. However, his symptoms did not improve. Eventually, a laparoscopic biopsy was performed for an accurate diagnosis. The histopathologic findings were presented in accordance to the typical characteristics of SEP. In spite of medical treatment, he did not show an improvement of clinical symptoms and radiologic findings. As a result, he died from nutritional deficiency, upper gastrointestinal bleeding, and congestive heart failure.

Encapsulating Peritoneal Sclerosis Occurring in a Hemodialysis Patient / 대한내과학회지

Encapsulating peritoneal fibrosis (EPF) is a serious, uncommon complication of chronic peritoneal dialysis. However, it is rare in hemodialysis patients. EPF is characterized by peritoneal membrane inflammation followed by peritoneal membrane fibrosis and encapsulation. The etiology is unclear, but inflammation of the deteriorated peritoneum causes peritoneal fibrosis. We present a case of EPF that occurred in a 29-year-old man with hepatitis B-associated liver cirrhosis with ascites that was treated solely with hemodialysis. We managed this patient surgically and then medically with prednisolone. To our knowledge, this is the first such case in Korea, so we report this case with a literature review.

Determining the encapsulation efficiency of dexamethasone-loaded nanoparticles using Sephadex gel column chromatography / 中国药学杂志

OBJECTIVE: To investigate the separating capacity of Sephadex gel for dexamethasone-loaded nanoparticles. METHODS: Single factor tests and central composite design-response surface methodology were employed for optimization of chromatographicparameters, and the established conditions were adopted to validate the encapsulation efficiency of dexamethasone-loaded nanoparticles. RESULTS: The optimal eluting condition was as follows: the ratio of diameter to height was 0.23, flowrate was 0.52 mL · min-1, and the amount of loaded drug was 41 μg. These paration degree reached 79.01%. CONCLUSION: Sephadex gel can be utilized properly to separate free drug from dexamethasone-loaded nanoparticles. Copyright 2012 by the Chinese Pharmaceutical Association.