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.

Encapsulating peritoneal sclerosis: case report / Esclerose peritoneal encapsulada: relato de caso

Abstract Patients with chronic kidney disease (CDK) can develop several diseases caused by the renal replacement therapy. Here we report a rare complication of peritoneal dialysis, the encapsulating peritoneal sclerosis (EPS) in which the peritoneal tissue is gradually replaced by fibrous tissue. The patient in question, after late loss of renal graft and conversion to peritoneal dialysis, evolved with multiple hospitalizations for spontaneous bacterial infections, in recent admission, he was diagnosed with sub-occlusive abdomen secondary to the EPS. Five days after, presented with intestinal obstruction requiring surgical approach by laparotomy, being performed with right colectomy, enterectomy, enteroraphy and ileostomy with drainage. The patient progressed well and follows on prednisone and tamoxifen-associated with intermittent hemodialysis.

Resumo No contexto da insuficiência renal crônica (IRC), os pacientes estão sujeitos a diversas patologias advindas da própria terapêutica de substituição renal. Relatamos aqui uma complicação rara da diálise peritoneal, a peritonite esclerosante encapsulante (PEE), na qual o tecido peritoneal é progressivamente substituído por tecido fibroso. O paciente em questão, após perda tardia de enxerto renal e conversão para terapêutica dialítica peritoneal evoluiu com múltiplas internações por infecções bacterianas espontâneas, em último internamento, foi diagnosticado com abdome sub-oclusivo secundário à PEE. Após 5 dias apresentou quadro de abdome obstrutivo com necessidade de abordagem cirúrgica por laparotomia exploradora, sendo realizado colectomia direita, enterectomia, enterorrafia e ileostomia com drenagem. O paciente evolui bem e segue em tratamento com prednisona e tamoxifeno associado à hemodiálise intermitente.

Diagnóstico y seguimiento de 12 casos de peritonitis esclerosante asociada a diálisis peritoneal crónica en Chile: Experience in 12 patients on peritoneal dialysis / Encapsulating peritoneal sclerosis

Background: Encapsulating peritoneal sclerosis (EPS) is a complication of peritoneal dialysis (PD) with a low prevalence but high mortality. It is characterized by peritoneal inflammation and fibrosis with subsequent development of intestinal encapsulation. It is associated with a long lapse on PD, frequent episodes of peritonitis, high glucose solution use, and high peritoneal transport status. Aim: To report the clinical features of patients on PD, who developed EPS. Material and Methods: Review of medical records of 12 patients aged 43 ± 10 years (eight women) who developed EPS. Results: The mean time spent on PD was 98 months. The main clinical manifestations were abdominal pain in 82% and ultrafiltration failure in 63%. In 92%, there was a history of peritonitis and 75% had high peritoneal transport at the time of diagnosis. The main findings in computed tomography were peritoneal calcification and thickening. There was a biopsy compatible with the diagnosis in 10 cases. Treatment consisted in withdrawal from PD, removal of PD catheter and the use of corticoids and tamoxifen. After withdrawal from PD 50% of patients became asymptomatic. The rest had intermittent abdominal pain and altered bowel movements. Two patients died (17%). Conclusions: EPS is a serious complication of PD, which should be suspected in any patient with compatible clinical symptoms, long time on PD, multiple episodes of peritonitis and high peritoneal transport profile.

Peritonite esclerosante encapsulante pós-diálise peritoneal / Sclerosing encapsulating peritonitis after peritoneal dialysis

Pacientes com insuficiência renal crônica terminal em uso de diálise peritoneal (DP) estão sujeitos a diversas complicações da própria terapia de substituição renal. Relatamos uma complicação rara da DP na qual o peritôneo, após anos de contato com a substância hipertônica dialisante, é gradualmente substituído por tecido fibroso. O paciente em questão 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 diminuição da ultrafiltração e episódios de suboclusão intestinal, sendo diagnosticado como peritonite esclerosante encapsulante (PEE). Atualmente, está em corticoterapia e com diminuição significativa dos sintomas e provável estabilização 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.

Assessement of peritoneal adhesions due to starch granules of surgical glove powder an experimental study

Introduction of foreign material into abdominal cavity during surgery causes irritation of peritoneum leading to postoperative [P0] adhesions. To assess and prevent P0 adhesions, an experimental study was done to assess the caused by starch granules of the surgical glove powder and to avoid complications using the effect of normal saline and low molecular weight heparin [LMWH]. Thirty Wister Albino male rats were subjected to laparotomy and ileocaecal abrasions were done mechanically to induce postoperative peritoneal adhesions. Rats were divided into 3 groups, 10 animals each. The sterile starch powdered gloves were used in the laparotomy procedure. The basic procedure performed in the three groups was serosal abrasions at the ileocaecal region and using the 2-layer technique in the closure of the abdominal cavity. In GI no further management was performed than the basic procedure. In GIl and G III before closure normal saline and [LMWH] was spilled into the peritoneal cavity respectively. The results showed that in GI, there were severe firm intraperitoneal adhesions especially at the site of the ileocaecal abrasions. This was proved macroscopically and histologically. The reactions detected in biopsies of GIl and GIll were lesser in intensity compared to GI. Morphometric assessment of collagen deposition in the intra-peritoneal adhesions revealed a significant decrease in GIl and GIll compared to GI