[Surgical treatment of sclerosing encapsulating peritonitis]. / Tratamiento quirúrgico de la peritonitis esclerosante.

OBJECTIVES: Sclerosing encapsulating peritonitis (SEP) or abdominal cocoon is a rare disease characterized by the formation of a fibrocollagenous membrane that wraps around the loops of the small bowel, producing obstruction. We present the results of the surgical treatment of this disease in three patients with chronic renal failure who developed SEP during the course of peritoneal dialysis (PD) and provide a literature review on the subject aimed at the general surgeon. PATIENTS AND METHOD: In our area, the PD program treated 150 patients in 14 years, with seven cases of suspected SEP. In three patients, exploratory laparotomy was required. Clinical data, diagnostic imaging tests, type of surgery, immediate postoperative course, and status of the patient during subsequent follow-up are described. RESULTS: In one of the three patients, bowel obstruction led to perforation requiring resection with anastomosis; the postoperative course was complicated and the patient died. In the remaining two patients, elective surgery was performed with the aim of removing the capsule enclosing the intestinal loops. In both patients the immediate postoperative course was favorable, although recurrence of intestinal encapsulation occurred in one patient. CONCLUSIONS: The success of surgery in this disease is determined by the technique used. The correct technique consists of freeing the adhesions and extirpating of the capsule as far as possible. Perforation, as well as resection and intestinal anastomosis, significantly increase mortality.

Tratamiento quirúrgico de la peritonitis esclerosante / Surgical treatment of sclerosing encapsulating peritonitis

Objetivos. La peritonitis esclerosante encapsulante (PES) o cocoon abdominal es una rara enfermedad que se caracteriza por la formación de una membrana fibrocolagenosa que envuelve las asas de intestino delgado y llega a producir cuadros de obstrucción intestinal. En este artículo presentamos los resultados del tratamiento quirúrgico en 3 pacientes con insuficiencia renal crónica que desarrollaron una PES en el curso de la diálisis peritoneal (DP) y se realiza asimismo una revisión de la literatura para acercar esta entidad al cirujano general. Pacientes y método. En nuestra área, el programa de DP ha tratado a 150 pacientes en 14 años, y se ha encontrado 7 casos de sospecha de PES. En 3 pacientes fue preciso realizar una laparotomía exploradora. Se describen los datos clínicos, las pruebas diagnósticas de imagen, el tipo de cirugía, la evolución en el postoperatorio inmediato y la situación del paciente en revisiones posteriores. Resultados. En 1 de los 3 pacientes, una obstrucción intestinal culminó en una perforación que obligó a una resección con anastomosis; la evolución postoperatoria fue muy complicada y desembocó en muerte. En los otros 2 casos, la intervención se realizó de manera electiva con el objetivo de extirpar la cápsula que envolvía las asas intestinales; la evolución postoperatoria inmediata en ambos fue favorable, aunque en uno de ellos terminó por recidivar la encapsulación intestinal. Conclusiones. El éxito de la intervención quirúrgica en esta afección está determinado por la técnica utilizada y el momento de la cirugía. La técnica correcta consiste en la liberación de las adherencias y extirpación de la cápsula en la medida de lo posible. Una complicación del cuadro obstructivo o la realización de resección y anastomosis intestinal aumentan la mortalidad de manera significativa (AU)

Objectives. Sclerosing encapsulating peritonitis (SEP) or abdominal cocoon is a rare disease characterized by the formation of a fibrocollagenous membrane that wraps around the loops of the small bowel, producing obstruction. We present the results of the surgical treatment of this disease in three patients with chronic renal failure who developed SEP during the course of peritoneal dialysis (PD) and provide a literature review on the subject aimed at the general surgeon. Patients and method. In our area, the PD program treated 150 patients in 14 years, with seven cases of suspected SEP. In three patients, exploratory laparotomy was required. Clinical data, diagnostic imaging tests, type of surgery, immediate postoperative course, and status of the patient during subsequent follow-up are described. Results. In one of the three patients, bowel obstruction led to perforation requiring resection with anastomosis; the postoperative course was complicated and the patient died. In the remaining two patients, elective surgery was performed with the aim of removing the capsule enclosing the intestinal loops. In both patients the immediate postoperative course was favorable, although recurrence of intestinal encapsulation occurred in one patient. Conclusions. The success of surgery in this disease is determined by the technique used. The correct technique consists of freeing the adhesions and extirpating of the capsule as far as possible. Perforation, as well as resection and intestinal anastomosis, significantly increase mortality (AU)