The Plication and Splinting Procedure for Idiopathic Sclerosing Encapsulating Peritonitis

Abstract

Idiopathic sclerosing encapsulating peritonitis (ISEP) is a rare cause of small intestinal obstruction. Histologically, ISEP is characterized by a thick fibrotic membrane encasing the small bowel without any apparent pathophysiological factors. While ISEP is predominantly present congenitally in female adolescents from subtropical region, it has been identified throughout the world. Evidence-based effective diagnostics and treatments are pitifully thin. We experienced six cases, four males and two females, which exhibited symptoms in their later thirties and forties. Five patients presented with acute and subacute intestinal obstruction, and one patient with cryptorchidism and seminoma was referred. Due to the limitation in distention and motility of bowel loops of ISEP, imaging exams may not be very reliable for accurate diagnosis and estimation of obstruction progress. They were successfully treated with the mesenteric plication and intraluminal splinting procedures. Two cases had an uneventful postoperative period, and the returns of normal bowel function were delayed in the other four patients. Two recurrences of small bowel obstructions were noted over a mean follow-up period of 33 months with mild symptoms. This article reviews the patterns of clinical presentations, diagnostic clues, and theories of potential risk factors of ISEP as well as its controversial surgical managements.

Sclerosing Encapsulating Peritonitis: Review

“…[1][2][3]5,37 Drug therapy may be initiated for patients who fail to respond to conservative treatment, including tamoxifen, steroids, colchicine, azathioprine and mycophenolic acid. 1,2,5,15,[37][38][39][40] Tamoxifen acts as an oestrogen receptor modulator that inhibits the fibroblastic production of transforming growth factor beta, while steroids inhibit collagen synthesis and maturation by suppressing the inflammatory process within the peritoneal membrane. 1,2,38,40 On the other hand, colchicine inhibits the messenger ribonucleic acid expression of transforming factor beta, thereby exhibiting an anti-inflammatory action.…”

“…Postoperative complications include early bowel obstruction, intra-abdominal infections, enterocutaneous fistulae, short bowel syndrome and bowel perforation. [1][2][3][4][5][6]16,39,44 Predisposing factors that enhance the risk of a postoperative obstruction include significant manipulation of the gut, oedema and prolonged duration of the operation. 2,5,35 Several methods can be employed to reduce the incidence of postoperative intestinal obstruction, including intestinal intubation through the orifice of the appendix in patients with type II or III SEP, the use of steroids to reduce oedema, intestinal stasis or bacterial translocation and somatostatin administration to reduce secretion and intestinal distension.…”

“…A review of case series involving five or more cases of SEP revealed a total of 118 cases [ Table 3]. 5,16,19,26,39 The mean patient age was 39 years with the majority being male (68.0%). Type I SEP was the most common finding (43.4%).…”

Long intestinal tube splinting prevents postoperative adhesive small-bowel obstruction in sclerosing encapsulating peritonitis

“…There were no deaths in our case series. The postoperative complications recorded in the previous studies were enterocutaneous fistula and early postoperative intestinal obstruction, at a rate of 8.7–66.7% [ 3 , 7 , 16 ]. These rates are greater than those in our study, wherein the overall complication rate was 6.8%, without any significant intergroup differences (P = 0.73).…”

“…SEP is a rare disease and most studies on this condition are based on a small number of patients and short follow-up periods [ 4 – 7 ]. The optimal treatment strategy for SEP remains controversial.…”