Enteritis cystica profunda

Abstract

Pneumoperitoneum has been reported in 11-34% of patients undertaking CAPD, usually in the absence of symptoms. 2-4 It is only the small minority with abdominal symptoms who create a diagnostic dilemma. Among general surgical patients with gastrointestinal perforation 60-80% have free subdiaphragmatic air on an erect chest X-ray. 5 In CAPD patients the specificity of this sign is much lower. Some workers have suggested that a large pneumoperitoneum is indicative of visceral perforation 3-4 but this is not always so. 6 Furthermore, peritoneal dialysis fluid may dilute the initial intraperitoneal contamination that follows gastrointestinal perforation and, together with intraperitoneal antibiotics, mask clinical signs. 7 Regular assessment is essential in those treated conservatively. In addition, the content of the CAPD effluent can be revealing: it may contain faeces, food or bile. If it does not, microscopy and Gram stain can be done quickly. Mixed Gram-negative or anaerobic organisms suggest perforation; a single organism, particularly if a staphylococcus, is more consistent with CAPD peritonitis (as in cases 1 and 2). Individuals with ESRF are often elderly, with co-morbidity, 8 and laparotomy presents a substantial risk. 9 Also it may necessitate termination of this mode of dialysis, as in case 3. The decision to operate should be based on microbiological evidence and the clinical judgment of the surgeon.

Enteritis cystica profunda: Case report and literature review

“…These findings supported our decision of diagnostic laparoscopy, intestinal segment resection, and primary anastomosis with good postoperative results. However, ECP does not require specific treatment by itself, unless the medical team suspects malignancy or mechanical complications such as bowel obstruction disease [11] . The development of malignancies such as adenocarcinoma is also described; for this reason, it is of utmost importance to obtain a surgical specimen in order to rule out malignancy [12] , [13] .…”

“…The development of malignancies such as adenocarcinoma is also described; for this reason, it is of utmost importance to obtain a surgical specimen in order to rule out malignancy [12] , [13] . In these cases, a diagnostic and therapeutic laparoscopy are indicated [11] .…”