Peritonitis esclerosante primaria y secundaria: estudio comparativo / Primary and secondary sclerosing peritonitis: comparative study

Resumen Introducción: Existen dos tipos de peritonitis esclerosante (PE): primaria o idiopática y secundaria, generalmente a diálisis peritoneal (DP), y con menor frecuencia a otras patologías abdominales o sistémicas. Su mortalidad es alta. Objetivo: Comparar las características clínicas, estudios diagnósticos y tratamiento de pacientes con Peritonitis Esclerosante Primaria y Secundaria, definir si existen diferencias y determinar los principales elementos clínicos e imagenológicos que permitan hacer un diagnóstico precoz y mejorar los resultados terapéuticos. Material y Métodos: Se analizan 18 casos de PE diagnosticados en nuestro hospital, entre los años 2001-2014. Incluye una serie retrospectiva de 15 casos de PE secundaria (13 por diálisis peritoneal y 2 por cirrosis hepática). Se compara con un estudio prospectivo que incluye 3 pacientes con PE primaria. Resultados: Las principales diferencias se evidencian en la presentación clínica: PE primaria: se presenta con cuadro de obstrucción intestinal y baja de peso de distinta magnitud. PE secundaria: predominan el dolor abdominal, peritonitis recurrente y la falla de ultrafiltración. La tomografía computada de abdomen es útil, sobre todo cuando hay obstrucción intestinal. Ha hecho posible el diagnóstico preoperatorio. Conclusiones: Se requiere un alto índice de sospecha para el diagnóstico precoz de PE, sobre todo para la forma primaria. Debe sospecharse en todo paciente con dolor abdominal, vómitos recurrentes y baja de peso de cualquier magnitud; y en aquellos en diálisis peritoneal durante 5 años o más, que presenten dolor abdominal y/o peritonitis recurrente y/o falla de ultrafiltración.

Introduction: There are two types of sclerosing peritonitis (SP): primary or idiopathic and secondary, generally to peritoneal dialysis, and less frequently, to other abdominal or systemic pathologies. Mortality related to this is high. Objective: To compare the clinical feature, diagnostic studies and treatment of patients with Primary and Secondary Sclerosing Peritonitis, to define whether there are any differences and to establish the main clinical and imaging elements allowing for an early diagnosis and improving the therapeutic results. Material and Methods: An analysis of 18 SP cases diagnosed at our hospital between 2001-2014 was carried out. This includes a retrospective series of 15 cases of secondary SP (13 to peritoneal dialysis and 2 to liver cirrhosis). This is compared against a prospective study that includes 3 patients with primary SP. Results: The main differences became evident in the clinical presentation: Primary SP: occurs in an intestinal obstruction and a loss of weight scenario of varying degrees. Secondary SP: abdominal pain and recurrent peritonitis as well as ultrafiltration failure prevail. CT of the abdomen has proven to be useful, in particular in those cases where there is intestinal obstruction. It has made preoperative diagnostic possible. Conclusions: A high degree of suspicion is required for an SP early diagnosis, especially for the primary form. All patients presenting abdominal pain, recurrent vomiting and any degree of weight loss and those with five or more years of peritoneal dialysis presenting abdominal pain and/or recurrent peritonitis and/or ultrafiltration failure should raise a diagnosis suspicion.

Sclerosing peritonitis mimicking ovarian carcinoma: Associated with ovarian teratoma / 대한산부인과학회지

Sclerosing peritonitis is an unusual fibrosing condition predominantly involving the omentum and simulating carcinoma. The presenting signs and symptoms, imaging examination and cancer antigen 125 (CA-125) status in sclerosing peritonitis sometimes resemble those of ovarian cancer. Thus, the possibility of sclerosing peritonitis should be considered in the differential diagnosis of ovarian carcinoma. It may occur idiopathically and secondary to chronic peritoneal dialysis, the use of peritoneovenous shunt, practolol therapy, or in association with ovarian tumors such as ovarian teratoma. We report a case of peritonitis initially suspected as ovarian carcinoma but diagnosed as sclerosing peritonitis associated with teratoma.

A Case of Idiopathic Sclerosing Peritonitis / 대한류마티스학회지

Idiopathic sclerosing peritonitis is a rare disease characterized by fibrosis and adhesion of the peritoneum to loops of the small intestine. It may be the cause of an unusual surgical emergency such as small bowel ileus. It is diagnosed predominantly in female adolescents. We report the case of an idiopathic sclerosing peritonitis in Korea. A 38-year-old man visited emergency room for recurrent small bowel ileus and migrating mass like lesion. Computed tomography (CT) of abdomen showed acute peritonitis with a diffuse wall thickening of terminal ileum and extraluminal fluid collectionaround the terminal ileum. He underwent laparotomy. The ileocolectomy with adhesiolysis was performed and its pathological examination revealed the characteristic findings of idiopathic sclerosing peritonitis. Symptoms recurred 2 months after surgery, but improved with steroid treatment.

A case of Meigs' syndrome and sclerosing peritonitis associated with fibrothecoma of bilateral ovary / 대한산부인과학회지

Fibrothecoma is mesenchymal tumor deriving from the ovarian stroma composed of theca-like elements and fibrous tissues. Fibroma is rarely associated with Meigs' syndrome which consists of an ovarian fibroma, ascites, and pleural effusion. And also, sclerosing peritonitis associated with thecoma of the ovary is a rare, but intriguing phenomenon characterized by striking peritoneal reactive fibrosis. We have experienced a case of Meigs' syndrome and sclerosing peritonitis associated with fibrothecoma of the bilateral ovaries in a 57-year-old woman. We report a case with brief review of literatures.

A Case of Sclerosing Peritonitis Successfully Treated with Corticosteroid Therapy / 대한신장학회잡지

Sclerosing peritonitis is a rare but fatal complication of peritoneal dialysis (PD). Management of sclerosing peritonitis includes cessation of PD, total parenteral nutrition, and surgery. Recently, a few reports have indicated immunosuppression might be beneficial in sclerosing peritonitis. In these reports, all of patients had the combination therapy of steroid and immunosuppressant. A 37-year old man develped sclerosing peritonitis 3 months after switching from PD to hemodialysis because of uncontrolled peritonitis. An abdominal computed tomography (CT) scan demonstrated massive ascites with multilocuated fluid collection and extensive enhancement of the peritoneum. A peritoneal biopsy showed proliferation of fibrous collagenous tissue with infiltration of lymphocytes. We started corticosteroid for one month. A follow-up CT scan showed complete resolution with absence of peritoneum thickness and fluid collection 16 months after corticosteroid therapy. The patient currently remains free of symptoms in an outpatient hemodialysis unit. To our knowledge, this is the first case of sclerosing peritonitis successfully treated with corticosteroid therapy alone in Korea.

Sclerosing Peritonitis with Gross Calcification: Case Report

Sclerosing peritonitis is an uncommon complication of continuous ambulatory peritoneal dialysis (CAPD) and can lead to small bowel dysfunction involving abdominal pain, progressive loss of ultrafiltration, and small intestinal obstruction. Peritoneal thickening, in which calcification can develop, often starts as a small plaque which gradually becomes larger. We report a case of CAPD-related calcifying peritonitis.

A case of a dialysis patient with sclerosing peritonitis initially suspected of tuberculous peritonitis / 대한내과학회지

Sclerosing peritonitis (SCP) is a syndrome of multiple causes that is characterized by the thickening of peritoneal membrane and subsequent ultrafiltration failure and intestinal obstruction. We report a case of sclerosing peritonitis initially suspected of tuberculous peritonitis in a patient with pulmonary tuberculosis. A 35-year-old man presented with recurrent exudative ascites of unknown origin. He had been switched from peritoneal dialysis to hemodialysis because of recurrent peritonitis 6 months ago. Laparoscopic peritoneal biopsy revealed excessive formation of capillaries and monocyte infiltration without evidence of tuberculosis. He was discharged without further treatment. Four months later, he was readmitted with intestinal obstruction. Exploratory laparotomy revealed that the whole small intestine was encased in a thick and fibrous peritoneal capsule. Pathologic examination of peritoneal membrane showed absence of mesothelium and extensive proliferation of fibroconnective tissue, which was compatible with sclerosing peritonitis.