[Surgical treatment of sclerosing encapsulating peritonitis].
OBJECTIVE
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.


METHODS
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.
Bujalance Cabrera
Francisco Manuel
FM
Servicio de Cirugía, Hospital Severo Ochoa, Leganés, Madrid, España. franbujalance@hotmail.com
Herrera Merino
Norberto
N
Salvador Fernández
Mariano
M
Escudero Escudero
Juana
J
Sierra Ortega
Miguel Angel
MA
Oliva Díaz
Catalina
C
Martínez Veiga
José Luis
JL
D000328:Adult; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications / Q000601:surgery; D008297:Male; D010538:Peritonitis / Q000150:complications / Q000601:surgery*; D012598:Sclerosis / Q000150:complications / Q000473:pathology; D013514:Surgical Procedures, Operative / Q000379:methods*