Sclerosing encapsulating peritonitis: Difference between revisions

Jump to navigation Jump to search
 
(18 intermediate revisions by 3 users not shown)
Line 1: Line 1:
{{Infobox_Disease |
{{Infobox_Disease |
   Name          = {{PAGENAME}} |
   Name          = {{PAGENAME}} |
   Image          = |
   Image          = Sclerosing encapsulating peritonitis 003.jpg|
   Caption        = |
   Caption        = Sclerosing encapsulating peritonitis. <br> [http://www.radswiki.net Image courtesy of RadsWiki]|
   DiseasesDB    = |
   DiseasesDB    = |
   ICD10          = |
   ICD10          = |
Line 14: Line 14:
}}
}}
{{SI}}
{{SI}}
{{CMG}}


'''Contributors:'''  [[User:zorkun|Cafer Zorkun]] M.D., PhD.


{{Editor Help}}


'''Synonyms and Related Keywords:''' Abdominal cocoon, sclerosing peritonitis, encapsulating peritonitis, peritonitis chronica fibrosa incapsulata.
 
'''Synonyms and Related Keywords:''' Abdominal cocoon, sclerosing peritonitis, encapsulating peritonitis, peritonitis chronica fibrosa incapsulata. <ref>Mustafa Kemal Demir, Okan Akinci, Ender Onur, and Neset Koksal. [http://radiology.rsnajnls.org/cgi/content/full/242/3/937 Case 108: Sclerosing Encapsulating Peritonitis.] Radiology 2007 242: 937-939.</ref>


==Overview==
==Overview==


'''Sclerosing encapsulating peritonitis''' (SEP) is a rare benign cause of acute or subacute [[small bowel obstruction]]. It is characterized by total or partial encasement of the small bowel within a thick fibrocollagenous membrane.
'''Sclerosing encapsulating peritonitis''' (SEP) is a rare benign cause of acute or subacute [[small bowel obstruction]]. It is characterized by total or partial encasement of the [[small bowel]] within a thick fibrocollagenous membrane.


==Etiology==
==Etiology==


* SEP can be idiopathic or mainly secondary to chronic ambulatory peritoneal dialysis, peritoneovenous or ventriculoperitoneal shunts, or treatment with practolol.  
* Sclerosing encapsulating peritonitis can be idiopathic or mainly secondary to [[peritoneal dialysis|chronic ambulatory peritoneal dialysis]], [[shunt|peritoneovenous]] or [[shunt|ventriculoperitoneal shunt]]s, or treatment with [[practolol]].  
* Various abdominal disorders such as [[tuberculosis]], [[sarcoidosis]], [[familial mediterranean fever]], gastrointestinal malignancy, [[protein S deficiency]], [[liver transplantation]], fibrogenic foreign material and luteinized ovarian thecomas are the other rare causative factors.
* Various abdominal disorders such as [[tuberculosis]], [[sarcoidosis]], [[familial mediterranean fever]], gastrointestinal malignancy, [[protein S deficiency]], [[liver transplantation]], fibrogenic foreign material and luteinized ovarian thecomas are the other rare causative factors.


==Differential Diagnosis==
==Differential Diagnosis==


SEP may be confused with congenital peritoneal encapsulation, which is characterized by a thin accessory peritoneal sac surrounding the small bowel. This asymptomtic condition is generally found incidentally during unrelated surgery and does not fit with the clinical or imaging findings in this group of patients.
Sclerosing encapsulating peritonitis may be confused with congenital peritoneal encapsulation, which is characterized by a thin accessory peritoneal sac surrounding the [[small bowel]]. This asymptomtic condition is generally found incidentally during unrelated surgery and does not fit with the clinical or imaging findings in this group of patients.
 
{| style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;" cellspacing="0" cellpadding="4" border="2"
|+'''Differentiating sclerosing encapsulating peritonitis from other causes of peritonitis'''
! colspan="2" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Disease'''}}
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Prominent clinical findings'''}}
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Lab tests'''}}
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Tratment'''}}
|-
| rowspan="3" |'''Primary peritonitis'''
|'''[[Primary peritonitis|Spontaneous bacterial peritonitis]]'''
|
* Absence of GI [[perforation]], most closely associated with [[cirrhosis]] and [[Liver disease|advanced liver disease]].
* Presents with abrupt onset of [[fever]], [[abdominal pain]], [[distension]], and [[rebound tenderness]].
|
* Most have clinical and biochemical manifestations of advanced [[cirrhosis]] or [[nephrosis]] like [[leukocytosis]],[[hypoalbuminemia]],
* Prolonged [[prothrombin]] time. SAAG >1.1 g/dL, increased serum [[lactic acid]] level, or a decreased [[Ascites|ascitic fluid]] pH (< 7.31) supports the diagnosis. [[Gram staining]] reveals bacteria in only 25% of cases.
* Diagnosed by analysis of the [[Ascitic|ascitic fluid]] which reveals [[WBC]] > 500/ML, and [[PMN]] >250cells/ml.
* [[Culture medium|Culture]] of ascitic fluid inoculated immediately into [[blood culture]] media at the bedside usually reveals a single [[Enteric Bacilli|enteric organism]], most commonly ''[[Escherichia coli]]'', ''[[Klebsiella]]'', or [[streptococci]].
|
* Once diagnosed,it is treated with [[Ceftriaxone]].
|-
|'''[[Tuberculous peritonitis]]'''
|
* Seen in 0.5% of new cases of [[tuberculosis]] particularly in young women in endemic areas as a primary infection.
* Presents with [[abdominal pain]] and [[distension]], [[fever]], [[night sweats]], [[weight loss]], and altered bowel habits.
|
* [[Ascites]] is present in about half of cases. [[Abdominal mass]] may be felt in a third of cases. The [[peritoneal fluid]] is characterized by a [[protein]] concentration > 3 g/dL with < 1.1 g/dL SAAG and [[Lymphocyte|lymphocyte predominance]] of [[WBC]].
* Definitive diagnosis in 80% of cases is by culture. Most patients presenting acutely are diagnosed only by [[laparotomy]].
|
* Combination [[Antituberculosis|antituberculosis chemotherapy]] is preferred in chronic cases.
|-
|'''[[Continuous ambulatory peritoneal dialysis|Continuous Ambulatory Peritoneal Dialysis]]''' [[Continuous ambulatory peritoneal dialysis|('''CAPD peritonitis)''']]
|
* [[Peritonitis]] is one of the major complications of [[peritoneal dialysis]] & 72.6% occurred within the first six months of [[peritoneal dialysis]].
* Historically, [[coagulase-negative staphylococci]] were the most common cause of peritonitis in [[Continuous ambulatory peritoneal dialysis|CAPD]], presumably due to touch contamination or infection via the pericatheter route.
* Treatment for [[peritoneal dialysis]]-associated peritonitis consists of [[Antimicrobial drug|antimicrobial therapy]], in some cases catheter removal is also warranted.
* Additional therapies for [[Peritonitis|relapsing or recurrent peritonitis]] may include [[Fibrinolytic agent|fibrinolytic agents]] and [[peritoneal lavage]]. Most episodes of peritoneal dialysis-associated peritonitis resolve with outpatient [[Antibiotic|antibiotic treatment]].
|
* Majority of [[peritonitis]] cases are caused by [[bacteria]] (50%-due to [[Gram-positive bacteria|gram positive]] organisms, 15% to [[gram negative]] organisms,20% were culture negative.2% of cases are caused by [[fungi]], mostly [[Candida]] species. Polymicrobial infection in 4%.Exit-site infection was present in 13% and a [[peritoneal fluid]] leak in 3 % and [[M.tuberculosis]] 0.1%.
|
* [[Antibiotic|Initial empiric antibiotic coverage]] for peritoneal dialysis-associated peritonitis consists of coverage for [[gram-positive]] organisms (by [[vancomycin]] or a [[Cephalosporins|first-generation cephalosporin]]) and [[gram-negative]] organisms (by a [[cephalosporin|third-generation cephalosporin]] or an [[aminoglycoside]]). Subsequently, the regimen should be adjusted based on [[Culture medium|culture]] and [[sensitivity]] data. Cure rates are approximately 75%.
|-
| rowspan="2" |'''[[Secondary peritonitis]]'''
|'''Acute [[bacterial]] [[secondary peritonitis]]'''
|
* Occurs after perforating, penetrating, inflammatory, infectious, or [[ischemic]] injuries of the GI or GU tracts. Most often follows disruption of a hollow viscus?chemical peritonitis?bacterial peritonitis(polymicrobial, includes [[aerobic]] [[gram negative]] {[[E coli]], [[Klebsiella]], [[Enterobacter]], [[Proteus mirabilis]]} and gram positive { [[Enterococcus]], [[Streptococcus]]} and [[anaerobes]] {[[Bacteroides]], [[clostridia]]}).
* Presents with [[abdominal pain]], [[tenderness]], [[guarding]] or rigidity, [[distension]], free peritoneal air, and diminished [[bowel sounds]]. Signs that reflect irritation of the parietal peritoneum resulting [[ileus]]. Systemic findings include [[fever]], [[chills]] or [[rigors]], [[tachycardia]], [[sweating]], [[tachypnea]], [[restlessness]], [[dehydration]], [[oliguria]], [[disorientation]], and, ultimately, refractory [[shock]].
|
|
* [[Peritoneal lavage]], [[Laparoscopy]] are the treatment of choice.
|-
|'''[[Biliary]] [[Secondary peritonitis|peritonitis]]'''
|
* Most often seen in cases of rupture of pathological [[gallbladder]] or [[bile duct]] or [[Cholangitis|cholangitic abscess]] or secondary to obstruction of  the [[biliary tract]].
* Seen in alcoholic patients with [[ascites]].
|
|
|-
| colspan="2" |'''[[Peritonitis|Tertiary peritonitis]]'''
|
* Persistence or recurrence of [[Infection|intraabdominal infection]] following apparently adequate therapy of [[Peritonitis|primary or secondary peritonitis]].
* Associated with [[Mortality|high mortality]] due to multi organ dysfunction. It presents in a similar way as other [[peritonitis]] but is recognized as an adverse outcome with poor prognosis.
|
* [[Enterococcus]], [[Candida]], [[Staphylococcus epidermidis]], and [[Enterobacter]] being the most common organisms.
|
* Characterized by lack of response to appropriate surgical and [[antibiotic therapy]] due to disturbance in the hosts [[immune response]].
|-
| colspan="2" |'''[[Familial mediterranean fever|Familial Mediterranean fever (periodic peritonitis, familial paroxysmal polyserositis)]]'''
|
* Rare [[Genetic disorder|genetic condition]] which affects individuals of Mediterranean genetic background.
* Etiology is unclear.
* Presents with recurrent bouts of [[abdominal pain]] and [[tenderness]] along with [[pleuritic]] or [[joint pain]]. [[Fever]] and [[leukocytosis]] are common.
|
|
* [[Colchicine]] prevents but does not treat acute attacks.
|-
| colspan="2" |'''[[Granulomatous peritonitis]]'''
|
* A rare condition caused by disposable surgical fabrics or food particles from a [[perforated ulcer]], eliciting a vigorous [[granulomatous]] ([[Hypersensitivity|delayed hypersensitivity]]) response in some patients 2-6 weeks after [[laparotomy]].
* Presents with [[abdominal pain]], [[fever]], [[nausea and vomiting]], [[ileus]], and systemic complaints, mild and diffuse [[abdominal tenderness]].
|
* Diagnosed by the demonstration of diagnostic Maltese cross pattern of starch particles.
|
* The disease is self-limiting.
* Treated with [[corticosteroids]] or [[Anti inflammatory medications|anti-inflammatory agents]].
|-
| colspan="2" |'''[[Sclerosing encapsulating peritonitis]]'''
|
* Seen in conditions associated with long term [[peritoneal dialysis]], shunts like [[Ventriculoperitoneal shunt|VP shunts]], history of [[Abdominal surgery|abdominal surgeries]], [[liver transplantation]].
* Symptoms include [[nausea]], [[abdominal pain]], [[diarrhea]], [[anorexia]], bloody [[ascites]].
|
|
|-
| colspan="2" |'''[[Abscess|Intraperitoneal abscesses]]'''
|
* Most common etiologies being [[Perforation|Gastrointestinal perforations]], postoperative complications, and penetrating injuries.
* Signs and symptoms depend on the location of the [[abscess]] within the [[peritoneal cavity]] and the extent of involvement of the surrounding structures.
* Diagnosis is suspected in any patient with a predisposing condition. In a third of cases it occurs as a sequela of [[Peritonitis|generalized peritonitis]].
* The pathogenic organisms are similar to those responsible for [[peritonitis]], but [[anaerobic]] organisms occupy an important role.
* The [[mortality rate]] of serious [[Abscesses|intra-abdominal abscesses]] is about 30%.
|
* Diagnosed best by [[CT-scans|CT]] scan of the abdomen.
|
* Treatment consists of prompt and complete [[CT]] or [[Ultrasound|US]] guided drainage of the [[abscess]], control of the primary cause, and adjunctive use of effective [[Antibiotics|antibiotics.]] Open drainage is reserved for [[abscesses]] for which percutaneous drainage is inappropriate or unsuccessful.
|-
| colspan="2" |'''[[Peritoneal mesothelioma]]'''
|
* Arises from the [[mesothelium]] lining the [[peritoneal cavity]].
* Its incidence is approximately 300-500 new cases being diagnosed in the United States each year.  As with [[pleural mesothelioma]], there is an association with an [[Asbestos|asbestos exposure]].
* Most commonly affects men at the age of 50-69 years. Patients most often present with [[abdominal pain]] and later increased abdominal girth and [[ascites]] along with [[anorexia]], [[weight loss]] and [[abdominal pain]].
* Mean time from diagnosis to death is less than 1 year without treatment. 
|
* [[Computed tomography|CT]] with [[Contrast|intravenous contrast]] typically demonstrates the thickening of the [[peritoneum]]. [[Laparoscopy]] with tissue biopsy or CT guided tissue biopsy with [[immunohistochemical staining]] for [[calretinin]], [[cytokeratin|cytokeratin 5/6]], [[mesothelin]], and [[WT1|Wilms tumor 1 antigen]] remain the [[Gold standard (test)|gold standard]] for diagnosis.
|
* At [[laparotomy]] the goal is cytoreduction with [[excision]]. Debulking surgery and intraperitoneal [[chemotherapy]] improves survival in some cases.
|-
| colspan="2" |'''[[peritoneal carcinomatosis]]'''
|
* Associated with a history of [[ovarian]] or [[Malignancy|GI tract malignancy]].
* Symptoms include [[ascites]], [[abdominal pain]], [[nausea]], [[vomiting]].
|
|
|}


==Diagnosis==
==Diagnosis==


*Radiographs of the abdomen can show air-fluid levels similar to those in patients with any other cause of small-bowel obstruction.  
*Radiographs of the abdomen can show air-fluid levels similar to those in patients with any other cause of small-bowel obstruction.  
*In the appropriate clinical setting, recognition of the entire dilated small bowel at the center of the abdomen and encased within a thick fibrocollageneous membrane, as though it were in a cocoon, on a CT image is diagnostic of SEP.  
*In the appropriate clinical setting, recognition of the entire dilated [[small bowel]] at the center of the abdomen and encased within a thick fibrocollageneous membrane, as though it were in a cocoon, on a [[CT]] image is diagnostic of sclerosing encapsulating peritonitis.  
*The other imaging findings may include signs of obstruction, fixation of intestinal loops, ascites or localized fluid collections, bowel wall thickening, peritoneal or mural calcification, and reactive adenopathy.
*The other imaging findings may include signs of [[intestinal obstruction|obstruction]], fixation of intestinal loops, [[ascites]] or localized fluid collections, bowel wall thickening, peritoneal or mural calcification, and reactive [[adenopathy]].


==Diagnostic Findings==
==Diagnostic Findings==


'''Patient #1: CT images demonstrate sclerosing encapsulating peritonitis. The patient was on long term peritoneal dialysis'''
'''Patient #1:  
 
[[CT]] and gross pathological images demonstrate sclerosing encapsulating peritonitis. The patient was on long term [[peritoneal dialysis]]'''


[http://www.radswiki.net Images courtesy of RadsWiki]
[http://www.radswiki.net Images courtesy of RadsWiki]


<gallery perRow="3">
<gallery perRow="2">
Image:Sclerosing encapsulating peritonitis 001.jpg
Image:Sclerosing encapsulating peritonitis 001.jpg
Image:Sclerosing encapsulating peritonitis 002.jpg
Image:Sclerosing encapsulating peritonitis 002.jpg
Line 55: Line 182:


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{SIB}}   


==See Also==
* [[Peritonitis]]
==External Links==
* [http://goldminer.arrs.org/search.php?query=Sclerosing%20encapsulating%20peritonitis Goldminer: Sclerosing encapsulating peritonitis]
{{Gastroenterology}}
   
[[Category:Gastroenterology]]
[[Category:Surgery]]




{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}

Latest revision as of 02:23, 24 August 2017

Sclerosing encapsulating peritonitis
Sclerosing encapsulating peritonitis.
Image courtesy of RadsWiki

WikiDoc Resources for Sclerosing encapsulating peritonitis

Articles

Most recent articles on Sclerosing encapsulating peritonitis

Most cited articles on Sclerosing encapsulating peritonitis

Review articles on Sclerosing encapsulating peritonitis

Articles on Sclerosing encapsulating peritonitis in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Sclerosing encapsulating peritonitis

Images of Sclerosing encapsulating peritonitis

Photos of Sclerosing encapsulating peritonitis

Podcasts & MP3s on Sclerosing encapsulating peritonitis

Videos on Sclerosing encapsulating peritonitis

Evidence Based Medicine

Cochrane Collaboration on Sclerosing encapsulating peritonitis

Bandolier on Sclerosing encapsulating peritonitis

TRIP on Sclerosing encapsulating peritonitis

Clinical Trials

Ongoing Trials on Sclerosing encapsulating peritonitis at Clinical Trials.gov

Trial results on Sclerosing encapsulating peritonitis

Clinical Trials on Sclerosing encapsulating peritonitis at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Sclerosing encapsulating peritonitis

NICE Guidance on Sclerosing encapsulating peritonitis

NHS PRODIGY Guidance

FDA on Sclerosing encapsulating peritonitis

CDC on Sclerosing encapsulating peritonitis

Books

Books on Sclerosing encapsulating peritonitis

News

Sclerosing encapsulating peritonitis in the news

Be alerted to news on Sclerosing encapsulating peritonitis

News trends on Sclerosing encapsulating peritonitis

Commentary

Blogs on Sclerosing encapsulating peritonitis

Definitions

Definitions of Sclerosing encapsulating peritonitis

Patient Resources / Community

Patient resources on Sclerosing encapsulating peritonitis

Discussion groups on Sclerosing encapsulating peritonitis

Patient Handouts on Sclerosing encapsulating peritonitis

Directions to Hospitals Treating Sclerosing encapsulating peritonitis

Risk calculators and risk factors for Sclerosing encapsulating peritonitis

Healthcare Provider Resources

Symptoms of Sclerosing encapsulating peritonitis

Causes & Risk Factors for Sclerosing encapsulating peritonitis

Diagnostic studies for Sclerosing encapsulating peritonitis

Treatment of Sclerosing encapsulating peritonitis

Continuing Medical Education (CME)

CME Programs on Sclerosing encapsulating peritonitis

International

Sclerosing encapsulating peritonitis en Espanol

Sclerosing encapsulating peritonitis en Francais

Business

Sclerosing encapsulating peritonitis in the Marketplace

Patents on Sclerosing encapsulating peritonitis

Experimental / Informatics

List of terms related to Sclerosing encapsulating peritonitis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Contributors: Cafer Zorkun M.D., PhD.


Synonyms and Related Keywords: Abdominal cocoon, sclerosing peritonitis, encapsulating peritonitis, peritonitis chronica fibrosa incapsulata. [1]

Overview

Sclerosing encapsulating peritonitis (SEP) is a rare benign cause of acute or subacute small bowel obstruction. It is characterized by total or partial encasement of the small bowel within a thick fibrocollagenous membrane.

Etiology

Differential Diagnosis

Sclerosing encapsulating peritonitis may be confused with congenital peritoneal encapsulation, which is characterized by a thin accessory peritoneal sac surrounding the small bowel. This asymptomtic condition is generally found incidentally during unrelated surgery and does not fit with the clinical or imaging findings in this group of patients.

Differentiating sclerosing encapsulating peritonitis from other causes of peritonitis
Disease Prominent clinical findings Lab tests Tratment
Primary peritonitis Spontaneous bacterial peritonitis
Tuberculous peritonitis
Continuous Ambulatory Peritoneal Dialysis (CAPD peritonitis)
Secondary peritonitis Acute bacterial secondary peritonitis
Biliary peritonitis
Tertiary peritonitis
Familial Mediterranean fever (periodic peritonitis, familial paroxysmal polyserositis)
  • Colchicine prevents but does not treat acute attacks.
Granulomatous peritonitis
  • Diagnosed by the demonstration of diagnostic Maltese cross pattern of starch particles.
Sclerosing encapsulating peritonitis
Intraperitoneal abscesses
  • Diagnosed best by CT scan of the abdomen.
  • Treatment consists of prompt and complete CT or US guided drainage of the abscess, control of the primary cause, and adjunctive use of effective antibiotics. Open drainage is reserved for abscesses for which percutaneous drainage is inappropriate or unsuccessful.
Peritoneal mesothelioma
peritoneal carcinomatosis

Diagnosis

  • Radiographs of the abdomen can show air-fluid levels similar to those in patients with any other cause of small-bowel obstruction.
  • In the appropriate clinical setting, recognition of the entire dilated small bowel at the center of the abdomen and encased within a thick fibrocollageneous membrane, as though it were in a cocoon, on a CT image is diagnostic of sclerosing encapsulating peritonitis.
  • The other imaging findings may include signs of obstruction, fixation of intestinal loops, ascites or localized fluid collections, bowel wall thickening, peritoneal or mural calcification, and reactive adenopathy.

Diagnostic Findings

Patient #1:

CT and gross pathological images demonstrate sclerosing encapsulating peritonitis. The patient was on long term peritoneal dialysis

Images courtesy of RadsWiki

References

  1. Mustafa Kemal Demir, Okan Akinci, Ender Onur, and Neset Koksal. Case 108: Sclerosing Encapsulating Peritonitis. Radiology 2007 242: 937-939.

See Also

External Links



Template:Gastroenterology


Template:WikiDoc Sources