Division of Coloproctology and Small Bowel, Alfa Institute of Gastroenterology, Federal University of Minas Gerais Hospital, Av. Alfredo Balena 110 - 2° andar, Belo Horizonte, MG 30130-100, Brazil.
Surg Today. 2011 Dec;41(12):1644-8. doi: 10.1007/s00595-010-4493-8. Epub 2011 Oct 4.
This report presents two cases of young males who developed the rare idiopathic form of sclerosing encapsulating peritonitis (SEP) presented as partial bowel obstruction, both diagnosed during surgical treatment, with satisfactory outcomes. Sclerosing encapsulating peritonitis is a rare and enigmatic condition, characterized by intraperitoneal fibrosclerosis, which causes intestinal obstruction. It is a chronic entity with a poorly elucidated pathophysiology, leading to the constitution of a thick white nacreous fibrosis membrane that wraps the bowel in a concertina-like fashion with some adhesions configuring an intra-abdominal cocoon. Sclerosing encapsulating peritonitis is reported in a wide variety of patients, including those who have undergone peritoneal dialysis, young adolescent girls, cirrhotic patients after peritoneal-venous shunting, and patients treated with β-blockers. Nevertheless, the etiology of SEP remains obscure. This entity presents many difficulties in preoperative diagnosis because of its peculiar characteristics. Recognition of the SEP results in proper management and prevents unnecessary bowel resection. Regardless of cause, the treatment of the obstruction is surgical, with dissection of the encasing membrane from the intestine and separation of adherent loops of small bowel until they are laid free and returned to their normal configuration. The prognosis after appropriate surgical therapy is good, but depends on coexisting diseases.
本报告介绍了两例年轻男性患者，他们均患有罕见的特发性硬化包裹性腹膜炎（SEP），表现为部分肠梗阻，均在手术治疗中诊断，结果满意。硬化包裹性腹膜炎是一种罕见且神秘的疾病，其特征为腹膜纤维化，导致肠梗阻。它是一种慢性疾病，其病理生理学尚未完全阐明，导致形成一层厚厚的白色珍珠状纤维膜，以手风琴状包裹肠道，一些粘连形成腹腔内的茧。硬化包裹性腹膜炎可见于多种患者，包括腹膜透析患者、年轻少女、门-体静脉分流后的肝硬化患者和接受β受体阻滞剂治疗的患者。然而，SEP 的病因仍不清楚。由于其特殊的特征，SEP 在术前诊断中存在许多困难。认识到 SEP 可进行适当的治疗，防止不必要的肠切除。无论病因如何，梗阻的治疗均为手术，从肠上剥离包裹膜，并分离粘连的小肠环，直到它们被松解并恢复正常形态。适当的手术治疗后预后良好，但取决于并存疾病。
