Case Of the Week (COW) 29 May 2016
Sclerosing encapsulating peritonitis in Chronic Renal Failure and Dialysis
Findings
Loculated ascites predominantly in the inframesocolic compartment with peritoneal thickening and few septations. Small bowel loops clustering within the fluid and posterior tethering are also noted. Comments : Features are suggestive of sclerosing encapsulating peritonitis in this patient who was on dialysis. Diffuse iron deposition in the liver and spleen with splenomegaly Bilateral contracted small kidneys reflecting Chronic kidney Disease Subsegmental Bibasal Lung Atelectasis also noted.
Discussion
Sclerosing encapsulating peritonitis (SEP) is a rare benign cause of acute or subacute small bowel obstruction. It is characterised by total or partial encasement of the small bowel within a thick fibrocollagenous membrane SEP was originally termed abdominal cocoon The major risk factor of sclerosing peritonitis is peritoneal dialysis treatment but it can also occur following renal or liver transplantation or be associated with peritoneovenous or ventriculoperitoneal shunts and treatment with practolol. .The entire dilated small bowel at the centre of the abdomen and encased within a thick fibrocollagenous membrane, as though it were in a cocoon, on a CT image is diagnostic of SEP. The other imaging findings may include signs of obstruction, fixation of intestinal loops, ascites or localised fluid collections, bowel wall thickening, peritoneal or mural calcification. Iron overload is reported to occur in patients with chronic renal failure treated with dialysis.This is more common when recombinant human erythropoietin (rHuEPO) therapy is not given. Iron overload is due to hypoproliferative erythroid marrow function coupled with the need for frequent red blood cell transfusions to manage symptomatic anemia.
Ref: Kidney Int Suppl. 1999 Mar;69:S35-43. Iron overload in renal failure patients: changes since the introduction of erythropoietin therapy. Eschbach JW1, Adamson JW American Journal of Roentgenology > Volume 195, Issue 1 > Imaging Features of Encapsulating Peritoneal Sclerosis in Continuous Ambulatory Peritoneal Dialysis Patients
Sclerosing encapsulating peritonitis in Chronic Renal Failure and Dialysis
Findings
Loculated ascites predominantly in the inframesocolic compartment with peritoneal thickening and few septations. Small bowel loops clustering within the fluid and posterior tethering are also noted. Comments : Features are suggestive of sclerosing encapsulating peritonitis in this patient who was on dialysis. Diffuse iron deposition in the liver and spleen with splenomegaly Bilateral contracted small kidneys reflecting Chronic kidney Disease Subsegmental Bibasal Lung Atelectasis also noted.
Discussion
Sclerosing encapsulating peritonitis (SEP) is a rare benign cause of acute or subacute small bowel obstruction. It is characterised by total or partial encasement of the small bowel within a thick fibrocollagenous membrane SEP was originally termed abdominal cocoon The major risk factor of sclerosing peritonitis is peritoneal dialysis treatment but it can also occur following renal or liver transplantation or be associated with peritoneovenous or ventriculoperitoneal shunts and treatment with practolol. .The entire dilated small bowel at the centre of the abdomen and encased within a thick fibrocollagenous membrane, as though it were in a cocoon, on a CT image is diagnostic of SEP. The other imaging findings may include signs of obstruction, fixation of intestinal loops, ascites or localised fluid collections, bowel wall thickening, peritoneal or mural calcification. Iron overload is reported to occur in patients with chronic renal failure treated with dialysis.This is more common when recombinant human erythropoietin (rHuEPO) therapy is not given. Iron overload is due to hypoproliferative erythroid marrow function coupled with the need for frequent red blood cell transfusions to manage symptomatic anemia.
Ref: Kidney Int Suppl. 1999 Mar;69:S35-43. Iron overload in renal failure patients: changes since the introduction of erythropoietin therapy. Eschbach JW1, Adamson JW American Journal of Roentgenology > Volume 195, Issue 1 > Imaging Features of Encapsulating Peritoneal Sclerosis in Continuous Ambulatory Peritoneal Dialysis Patients