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배상철 ( Sang Chul Bae ),박주현 ( Joo Hyun Park ),장한얼 ( Han Eol Chang ),이주현 ( Joo Hyun Lee ),김유선 ( You Sun Kim ),나종천 ( Jong Chum Nah ),윤보영 ( Bo Young Yoon ) 대한류마티스학회 2014 대한류마티스학회지 Vol.21 No.1
Sclerosing encapsulating peritonitis (SEP) is characterized by peritoneal fibrosis and adhesion of the peritoneum with the loops of the small intestine. Although the prevalence is low, most cases are caused by peritoneal dialysis, infection, medication, systemic lupus erythematosus (SLE), and intra-abdominal neoplasm. We describe a 22-year old man who was presented with abdominal pain and distension, which were attributed to SLE with peritonitis. He had no specific history of previous medical illness and peritoneal dialysis. He was treated with intravenous high dose methylprednisolone 1 g/day for 3 days, followed by intravenous methylprednisolone 1 mg/kg daily and immunoglobulin. However, his symptoms did not improve. Eventually, a laparoscopic biopsy was performed for an accurate diagnosis. The histopathologic findings were presented in accordance to the typical characteristics of SEP. In spite of medical treatment, he did not show an improvement of clinical symptoms and radiologic findings. As a result, he died from nutritional deficiency, upper gastrointestinal bleeding, and congestive heart failure.
LC : Sclerosing Encapsulating Peritonitis (“Abdominal Cocoon”) in a Patient with Alcoholic Cirrhosis
( Hyun Woo Park ),( Hae Min Yang ),( Soo Young Park ),( Won Young Tak ),( Young Oh Kweon ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1
Background: Sclerosing encapsulating peritonitis (SEP) is a form of intraperitoneal fibrosclerosis that causes intestinal obstruction. SEP has been reported in a wide variety of patients, including those who have undergone peritoneal dialysis (PD), young adolescent girls, cirrhotic patients after peritoneovenous shunt (PVS) or liver transplantation, and patients treated with β-blockers. The etiology of SEP remains unclear. We experienced SEP presented with recurrent episodes of intestinal obstruction in alcoholic cirrhosis patient. Case: A 58 year old man presented with recurrent nausea, vomiting and abdominal pain. He had been treated for alcoholic liver cirrhosis since 4 years ago. He had never received PD or PVS, and had never been treated with β-blockers. He had been treated for intractable ascites due to alcoholic liver cirrhosis for several years by diuretics and repeated paracentesis. Conventional radiography showed dilated bowel loop and air-fluid level. Abdominal computed tomography scan showed that the small bowel was restricted to the right lower quardrant of the abdomen due to fibrous mesentery and bowel loop mass encased in a membrane. He was diagnosed as SEP by imaging and clinical symptoms. For several episodes of intestinal obstruction, he had successfully been treated by bowel decompression with nasogastric tube and total parenteral nutrition (TPN). Surgical intervention such as adhesiolysis was not possible due to a high risk of mortality by underlying liver cirrhosis. On the last admission, hepatorenal syndrome developed and he finally died. Conclusions: SEP is a rare form of peritonitis that causes intestinal obstruction. In cirrhotic patients with intractable ascites, spontaneous bacterial peritonitis may recur frequently. In case of intestinal obstruction in cirrhotic patient with intractable ascites, it is necessary to look for evidence of SEP whether to introduce surgical intervention such as adhesiolysis or medical treatment, even though its prognosis is poor.
Sclerosing Encapsulating Peritonitis (Abdominal Cocoon) after Abdominal Hysterectomy
Suh, Won Na,Lee, Sang Kil,Chang, Hyun,Hwang, Hye Jin,Hyung, Woo Jin,Park, Young Nyun,Kim, Tae Il The Korean Association of Internal Medicine 2007 The Korean Journal of Internal Medicine Vol.22 No.2
<P>Sclerosing encapsulating peritonitis (SEP) is a poorly understood and rarely documented cause of small bowel obstruction. Although recurrent peritonitis has been reported as the main contributory factor leading to secondary SEP, the pathogenesis of primary (idiopathic) SEP is still uncertain.</P><P>A 40-year-old woman with a history of total abdominal hysterectomy due to gestational trophoblastic disease presented with progressive lower abdominal pain and abdominal distension. Ultrasonography and contrast-enhanced abdomen-pelvis computed tomography of the abdomen revealed encapsulation of the entire small bowel with a sclerotic capsule. At laparotomy, a fibrous thick capsule encasing small bowel loops was revealed. Extensive adhesiolysis and removal of the capsule from the bowel loops were performed. The patient recovered uneventfully; she was discharged without complications.</P><P>SEP is a rare cause of small bowel obstruction. We treated a case of abdominal cocoon with intestinal partial obstruction in a woman with a history of abdominal hysterectomy due to gestational trophoblastic disease. Surgical treatment was effective and the patient recovered without complication.</P>
Sclerosing encapsulating peritonitis after living-donor liver transplantation
Vusal Aliyev,Shintaro Yagi,Ahmed Hammad,Amr Badawy,Yudai Sasaki,Yuki Masano,Gen Yamamoto,Naoko Kamo,Kojiro Taura,Hideaki Okajima,Toshimi Kaido,Shinji Uemoto 한국간담췌외과학회 2018 Annals of hepato-biliary-pancreatic surgery Vol.22 No.2
Sclerosing encapsulating peritonitis (SEP), or abdominal cocoon is a rare cause of intestinal obstruction, and still etiology remains unknown. We report a series of 4 patients with abdominal cocoon, and all the 4 patients had previously undergone living-donor liver transplantation (LDLT). There was no evidence of SEP before and during LDLT. At the time of diagnosis of SEP, 3 out of 4 patients had ascites. First and fourth patients had multiple episodes or attacks of cholangitis, which were managed by percutaneous transhepatic biliary drainage and hepaticojejunostomy, respectively. All 4 patients presented with intestinal obstruction and 3 of them underwent a successful operation. The fourth patient died due to liver failure and complications of the SEP. The first 3 patients are doing well without SEP recurrence. Our experience suggest that the prognosis of SEP is poor in patients with poor graft liver functions after LDLT.