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Surgical treatment for sclerosing encapsulating peritonitis
H Kawanishi1, Y Harada, E Sakikubo
1Akane-Foundation, Tsuchiya General Hospital, Hiroshima, Japan.
Advances in Peritoneal Dialysis. Conference on Peritoneal Dialysis
|October 25, 2000
Summary
Sclerosing encapsulating peritonitis (SEP), a complication of continuous ambulatory peritoneal dialysis (CAPD), can be treated with total intestinal enterolysis when steroids or TPN fail. This surgical approach offers a satisfactory outcome for patients.
Area of Science:
- Nephrology
- Gastroenterology
- Surgical Pathology
Background:
- Sclerosing encapsulating peritonitis (SEP) is a severe complication of continuous ambulatory peritoneal dialysis (CAPD).
- SEP development is often observed after peritoneal catheter removal.
- Early intervention is crucial for managing SEP.
Purpose of the Study:
- To evaluate the efficacy of active interventions for treating sclerosing encapsulating peritonitis (SEP).
- To determine the optimal treatment strategy for SEP based on patient history and disease severity.
Main Methods:
- Review of 12 cases of SEP treated at the hospital.
- Analysis of treatment outcomes including steroid administration, total parenteral nutrition (TPN) after laparotomy, and total intestinal enterolysis.
- Assessment of encapsulation and adhesion severity in relation to duration of peritoneal dialysis (PD) and immunosuppressant use.
Main Results:
- Steroid administration relieved SEP in 3 patients; TPN after laparotomy in 1 patient.
- Total intestinal enterolysis successfully treated 8 patients with SEP.
- Varied severity of encapsulation and adhesion was noted, with more severe cases observed after longer PD duration or immunosuppressant use.
Conclusions:
- Total intestinal enterolysis is an effective treatment for SEP when conservative measures fail.
- The surgical approach should be tailored to the severity of encapsulation and adhesion.
- Avoiding intestinal impairment during surgery is critical for successful outcomes.