The enigma of primary and secondary encapsulating peritoneal sclerosis

Abstract

BackgroundEncapsulating Peritoneal Sclerosis (EPS) describes a variety of diseases that are frequently confused with different names and different etiopathogeneses. The aim of this article is to report personal experience of focusing on correct classification and the status of current diagnosis and treatment.MethodsA retrospective analysis was performed. Age, sex, ethnic origin, past medical history, symptoms and their duration, radiological tools and signs, laboratory tests, preoperative diagnosis, surgical approach, intraoperative findings, pathological findings, hospital stay, morbidity and mortality were studied.ResultsA total of seven patients, including six males and one female, aged from 24 to 72 years were observed. Four patients had recurrent abdominal colic pain for 3 months, 1, 2 and 9 years; two patients also reported recurrent attacks but without any specification of the duration. All seven patients presented at the emergency department with abdominal pain that was mainly diffused over the entire abdomen. Six patients were submitted to a CT scan. Only in two patients was the diagnosis of EPS made preoperatively. All seven patients were submitted to open surgery. The hospital stay was between 4 and 60 days. One patient had morbidity, and one patient died of MOF.ConclusionsCurrently, the correct identification of EPS is more easily possible than in the past, but the diagnosis is still a challenge. Surgery must be performed as soon as possible to avoid a poorer quality of life.

Abdominal cocoon: a surgical challenge

“…Two variants are usually seen, primary and acquired (secondary). 9 Primary are seen in adolescent girls in tropical and subtropical countries. It is attributed to retrograde menstruation.…”

Secondary encapsulating peritonitis: a study of cases over five years

“…The basis of any surgery is the removal of the membrane and division of any adhesions. Various procedures described in the literature include resection of the peritoneum and fibrous tissue and separation of adhesions to release the bowel, partial membrane excision with adhesiolysis, resection and anastomosis, resection and anastomosis with protective stoma, depending on patient-related factors (3,14). However, Wang et al (10) have found surgery not very helpful in patients with cocoon secondary to carcinoma in their study.…”

“…Contrast-enhanced computed tomography (CECT) is the most helpful radiological tool for confirming the diagnosis, planning therapy, and avoiding unnecessary resection in patients with SEP (11). Characteristic CT finding helpful in clinching the diagnosis is conglomeration of contrast dense small bowel loops in the centre encased by contrast free capsule in the periphery (3).…”

“…The condition is characterized by partial or complete encapsulation of the bowel resulting in bowel obstruction of varying degrees associated with an inflammatory process of the peritoneum. A separate distinct condition is primary peritoneal encapsulation which is essentially a congenital duplication of the peritoneum in the absence of any inflammatory or sclerotic process (3). A preoperative diagnosis is seldom made and most of the cases are detected at laparotomy performed for small bowel obstruction.…”

Sclerosing encapsulating peritonitis: a rare case presenting as intestinal obstruction

“…Most common in adolescent girls. 1 Common causes like idiopathic, peritoneal dialysis related, malignancy (NET, dermoids), drugs like β blockers, ergot, generalized peritonitis. 2,3 According to BoWei classification, its divided into 3 types, 3 types according to extent of encasing membrane: Type I membrane encapsulates small intestine partially.…”