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Sclerosing Encapsulating Peritonitis Definition, Symptoms, Causes, Treatment

   

It is a pathological condition in which a small bowel is encapsulated in the fibrocollagenous membrane. This encasement may be total or partial. Sclerosing encapsulating peritonitis is considered one of the cause behind acute or sub-acute small bowl obstruction. Talking about the term sclerosing encapsulating peritonitis, it was originally termed as abdominal cocoon. Other names for sclerosing encapsulating peritonitis are encapsulating peritonitis, sclerosing peritonitis and peritonitis chronica fibrosa incapsulata. It is basically the inflammation of peritoneal cavity with fatal outcome.


The peritoneal dialysis treatment is the major risk factor of sclerosing encapsulating peritonitis. There may be many other reasons behind it like liver or renal transplantation and secondary to any drug treatment. Sclerosing encapsulating peritonitis involves both the visceral and parietal surfaces of abdominal cavity. It is a slow disease process and have low incidence. Dialysis of peritoneal cavity is the major risk factor associated with sclerosing encapsulating peritonitis.

The peritoneal membrane may become structurally and functionally damage. People having peritoneal dialysis for more than 4 to 5 years may develop sclerosing encapsulating peritonitis. It is a rarely occurring disease with main complication i.e. peritoneal dialysis. The incidence of occurrence of sclerosing encapsulating peritonitis is about 0.7 to 3.3 percent. It has high mortality rate i.e. more than 50 percent.

Sclerosing Encapsulating Peritonitis Definition, Symptoms, Causes, Treatment

Sclerosing Encapsulating Peritonitis Symptoms


Sclerosing encapsulating peritonitis is a rare but fatal condition. Patient may experience symptoms related to bowel. As a small part of bowel is encapsulated with a fibrous sheet or we can say membrane. This membrane causes various complications. There may be obstruction of bowel due to encapsulation. Mural fibrosis with anorexia is a symptom. Nausea and vomiting are the common symptoms of sclerosing encapsulating peritonitis. These symptoms often leads to malnutrition. This is a fatal condition because when patient will not able to digest something, then patient may suffer from malnutrition and eventually die.

Sclerosing Encapsulating Peritonitis Causes


Sclerosing encapsulating peritonitis may occur secondary to some conditions or may be idiopathic. It may occur secondary to some drug treatment like practolol, chronic ambulatory peritoneal dialysis and ventriculoperitoneal and peritoneovenous shunts. Other causes may include familial Mediterranean fever, sarcoidosis, liver transplantation, tuberculosis, gastrointestinal malignancy and fibrogenic foreign material. Other than these common causes, there is a rare cause i.e. luteinised ovarian thecomas. Usually patients having peritoneal dialysis for more than 4 to 5 years develop sclerosing encapsulating peritonitis easily and it may prove fatal for patient.

Sclerosing Encapsulating Peritonitis Treatment


Talking about the treatment of sclerosing encapsulating peritonitis, surgical procedure is recommended. Laparotomy is performed to check the severity of condition. Then most suitable surgical procedure is recommended like adhesiolysis and segmental resection. In addition to treatment therapy, peritoneal dialysis should be replaced with hemodialysis to avoid further complications.

Total parental nutrition TPN is recommended to relax bowel. As it helps a lot in relieving symptoms. Medications involve methotrexate and corticosteroids which help in treatment. Tamoxifen is also used for sclerosing encapsulating peritonitis. If bowel obstruction is diagnosed, then surgery is recommended. But the mortality rate is higher that's why it is risky.

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