Sclerosing encapsulating peritonitis secondary to dermoid cyst rupture: a case report

This case report documents the presentation and management of a 26-year-old female patient diagnosed with SEP secondary to dermoid cyst rupture. The authors postulate that acute chemical peritonitis secondary to dermoid cyst rupture can develop into SEP resulting in the clinical features depicted in this case report.     

Sclerosing encapsulating peritonitis after living donor liver transplantation: a case successfully treated with tamoxifen: report of a case

Sclerosing encapsulating peritonitis (SEP) is a rare cause of bowel obstruction. It is difficult to diagnose and the prognosis is poor. This report describes a case of SEP after living donor liver transplantation that was successfully treated with tamoxifen. A 56-year-old male, that had received a liver transplant for hepatitis C virus-related hepatocellular carcinoma 5 years earlier, was admitted with continuous abdominal pain and nausea. He had increased C-reactive protein levels and white blood cell count, and underwent laparotomy 5 days after hospitalization. The surgical findings showed ascites and SEP of the small bowel. An attempt to peel off the adhesions was stopped because there was a strong risk of intestinal tract damage. Tamoxifen treatment was initiated for SEP after surgery. The patient’s symptoms gradually improved and he was able to resume feeding. He had been symptom-free for over 3 years at the last follow-up.     

Sclerosing peritonitis following continuous ambulatory peritoneal dialysis

Sclerosing peritonitis is a severe complication after CAPD treatment. The visceral peritoneum is thickened and interenteric adhesive parts are found. Myofibroblasts are proliferated and the collageneous tissue is hyperplastic. The mean clinical symptom is the mechanical obstruction of the small bowel. We observed this illness in three out of sixty patients under CAPD. These patients had higher incidence of bacterial peritonitis. In the ascites high concentrations of PG E2 and Thromboxan B2 were observed. After treatment of the infection the concentrations fell down to normal values. Electronoptical observations from peritoneal biopsies showed a proliferation of myofibroblasts and extracellular lysosomes. It is known from these lysosomes that they are able to set free proteasis. These lead to degredation of fibrin and fibrinogen. These splits are mitogen to myofibroblasts. release from HIT cells could also be evoked by the sulphonylureas glibenclamide and tolbutamide and by an increase in concentration of extracellular K+ to 40 mmol/l. The content of cyclic AMP in HIT cells was increased modestly by glucose but not by an increase in extracellular K+. Forskolin elicited a 4-fold increase in cyclic AMP content. We conclude that HIT cells retain the essential features of the insulin secretory response of normal B cells and represent an important tool for further biochemical characterisation of the secretory system.     

Sclerosing peritonitis: report of three cases

Sclerosing peritonitis is a dramatic complication of continuous ambulatory peritoneal dialysis and chronic peritoneal inflammation. Both visceral and parietal surfaces of the peritoneal cavity are involved. A thickened peritoneum encloses the small intestine in a "cocoon" formation which often leads to intestinal occlusion. CT scan may help obtaining an early diagnosis but diagnosis is often established with some delay or even at the time of laparotomy. Our report describes three cases of this uncommon peritoneal fibrosis syndrome which caused intestinal obstruction requiring surgical intervention.     

Sclerosing encapsulating peritonitis in a child secondary to peritoneal dialysis

Sclerosing encapsulating peritonitis, or “abdominal cocoon,” is a rare but serious complication of continuous ambulatory peritoneal dialysis. It is characterized by the diffuse appearance of marked sclerotic thickening of the peritoneal membrane resulting in intestinal obstruction.A 14-year-old adolescent boy with a history of end-stage renal failure on continuous ambulatory peritoneal dialysis presented with symptoms of acute intestinal obstruction. A computed tomography scan of the abdomen revealed distended small bowel loops clustered and displaced to the right upper quadrant. The overlying peritoneum was markedly thickened and calcified. Laparotomy confirmed the diagnosis of sclerosing encapsulating peritonitis and the patient was treated with excision of the fibrocollagenous membrane. Postoperatively, he had prolonged ileus requiring parenteral nutritional support and peritoneal dialysis was restarted on postoperative day 10.A high degree of cognizance is needed to facilitate diagnosis and treatment of this uncommon and potentially life-threatening condition.     

Sclerosing encapsulating peritonitis in pediatric peritoneal dialysis patients

The aim of this study was to define the incidence and characteristics of sclerosing encapsulating peritonitis (SEP) in pediatric peritoneal dialysis (PD) patients in Japan. A questionnaire was sent to all dialysis units with at least two pediatric PD patients. Among 687 patients registered, 11 cases (1.6%) of SEP were diagnosed. The mean age of patients with SEP at the start of PD was 9.7±3.6 years and at SEP diagnosis, 19.1±3.8 years. All patients had undergone PD for more than 5 years, and the mean PD duration was 9.6±3.3 years. SEP was diagnosed in 6.6% and 12% of patients dialyzed for >5 years and >8 years, respectively. The incidence of peritonitis among patients with SEP was not different from that among the Japanese pediatric registry. All patients had virtually no residual urine volume and 9 had impaired peritoneal ultrafiltration. Peritoneal calcification was the most-frequent radiological finding. Peritoneal biopsy was performed in 7 patients and confirmed sclerotic peritonitis in all. Ten patients transferred to hemodialysis, and only 1 patient underwent surgery. Three patients died. We recommend that patients on PD for more than 5 years who have impaired peritoneal ultrafiltration or peritoneal calcification should be carefully managed as presumptive cases of SEP. Received: 25 February 1999 / Revised: 9 July 1999 / Accepted: 13 July 1999     

Sclerosing peritonitis caused by disinfectant in a patient under peritoneal dialysis

An uraemic patient under intermittent peritoneal dialysis was found in the 9th month of treatment to present ultrafiltration drop and increase of low-molecular weight substances. Two instances of laparotomy for heavy abdominal bleeding revealed peritoneal thickening, laminar intestinal concrescence and diffuse haemorrhage. The patient died in the 13th month of treatment under symptoms of ileus. Other reasons excluded, sclerosing peritonitis was attributed to the formalin solution employed as disinfectant for the abdominal catheter. The causative factors are listed together with the chances of prevention.     

Sclerosing polycystic adenosis: a case report

About 70 to 80 percent of all salivary gland neoplasms, the majority of which are benign, arise in the parotid gland. Sclerosing Polycystic Adenosis (SPA) is a relatively unknown and newly described entity that is considered to be benign in nature. A 55-year-old patient was treated for SPA in our hospital. The diagnostic work-up consisted of Magnetic Resonance Imaging (MRI), Fine Needle Aspiration Cytology (FNAC) and histological examination. However, in our case, both the cytological appearance, which usually has a high accuracy in discriminating benign from malignant lesions, and the appearance on MR images, mimicked a malignant tumour. This case report illustrates the importance of an adequate histological confirmation of the work-up diagnosis.     

Aspergillus peritonitis in peritoneal dialysis: case report and a review of the literature

Aspergillus peritonitis is a rare complication of continuousambulatory peritoneal dialysis. The case is described of a 68-year-oldman in whom Aspergillus fumigatus was isolated from the peritonealdialysate after recurrent peritonitis with Gram-negative rodsin association with diverticulosis. Treatment consisting ofremoval of the catheter and intravenous administration of amphotericinB followed by oral itraconazole was successful. A review of the sparse literature (12 cases) displays uncertaintiesregarding diagnostic awareness, culture diagnosis, and therapeuticmanagement. Next to institution of appropriate antifungal therapy,early removal the peritoneal dialysis catheter is recommended,as delayed removal of the catheter appears to be associatedwith increased mortality and morbidity.     

Rothia dentocariosa repeat and relapsing peritoneal dialysis-related peritonitis: a case report and literature review

Peritonitis is well recognized as the Achilles tendon of peritoneal dialysis (PD). Reoccurrence of peritonitis due to the same organism, defined as either repeat or relapsing peritonitis under the 2005 guidelines by the International Society for Peritoneal Dialysis, often results in PD technique failure. Rothia dentocariosa, a low-virulent human oropharynx commensal, is a rarely reported pathogen in human infection, particularly infective endocarditis. R. dentocariosa PD-related peritonitis is exceedingly uncommon yet potentially results in repeat or relapsing peritonitis which requires catheter removal. We report a case of R. dentocariosa repeat and relapsing peritonitis in a PD patient who was treated successfully with antimicrobial therapy.     

Cerebral schistosomiasis with a huge calcification. A case report

A case of cerebral schistosomiasis with a huge calcification and with a long clinical course was reported. A 39-year-old male developed ataxic gait gradually associated with headache and general fatigability. According to the past history, the patient had suffered from severe meningitis with disturbance of consciousness for 2 weeks when he was 10 years of age. Neurological examination revealed positive Romberg's sign and left homonymous hemianopsia. Plain craniogram showed a large calcification occupying the whole right occipital region. This calcification was lobulated in shape and was 11 X 9 X 9 cm in size. CT scan demonstrated calcification and remarkable hydrocephalus. This calcification had no mass effect. Left vertebral angiogram revealed the right parieto-occipital artery to be stretched and slightly displaced toward midline. Hematological analysis disclosed no abnormality except for eosinophilia (10%). Pre-operative diagnosis was an old calcified granuloma of unknown origin. For the purpose of biopsy, a right occipital craniotomy was performed. On reflecting the dura, fibrous adhesion and vascular network were seen between the inner table of the dura and the arachnoid. Subarachnoid space was enlarged and all cortical vessels were narrow in their diameters. By a corticotomy, a whitish-yellow calcified mass was seen in the depth of 2 mm. The yellowish gelatinous content poured out of the mass. A piece of calcification and a small amount of content were taken as specimen. Microscopic study of the calcified tissue showed many egg shells of schistosoma japonica, necrotic tissues and infiltration of small round cells.     

Sclerosing epithelioid fibrosarcoma. A case report

Sclerosing epithelioid fibrosarcoma is a rare variant of fibrosarcomas, which was recently identified as a separate entity due to specific histologic and immunohistochemistry features and its poor prognosis. We report a case of sclerosing epithelioid fibrosarcoma of soft tissues, which developed in a 37-year-old woman who presented a tumor involving the posteromedial aspect of the left knee and which progressed in size for one year. Imaging revealed a well-delimited tumor process measuring 8 cm in its largest diameter and situated in the medial compartment of the left knee. Histology of the tumorectomy specimen and the immunohistochemistry study led to the diagnosis of sclerosing epithelioid fibrosarcoma of soft tissues. This new case illustrates the characteristic features of this tumor and recalls the difficult pathological diagnosis.