Sclerosing peritonitis - operative tactic issues in a patient with ruptured ovarian cyst

A. Manta, E. Brătilă, C. Iorga, D. Comandașu, V.D.E. Strâmbu, F. Popa, C.I.M. Iorga

Rezumat: Encapsulated peritoneal sclerosis or sclerosing peritonitis is a clinical-morphological entity that raises real challenges for the diagnosis and the treatment. Although it occurs in many other conditions, it represents a complication of peritoneal dialysis closely related to its long-period use. The purpose of this article is to present the case of a 26-year-old patient with lupus erythematosus systemic and chronical renal failure who has been in the peritoneal dialysis program for 11 years, in whom surgery was performed for haemoperitoneum caused by a ruptured ovarian cyst and intraoperatively was found encapsulated peritoneal sclerosis, and discuss the risk factors, diagnosis difficulties and surgical challenges of the disease. The diagnosis is based on symptoms, imagistics and histopathology, but often constitutes an incidental finding during other interventions. The treatment for sclerosing peritonitis is medical and surgical. Medical treatment with corticosteroids, immunosuppressive and antifibrotic agents has questionable results. Surgical treatment is based primarily on peritoneal dialysis catheter removal and switching patients on hemodialysis. Fibrotic membrane removal is attempted in the gut or, if not possible, multiple relaxation incisions aremade in this membrane. In the presence of complications we can practice multiple segmentary bowel resections with anastomosis or enterrorraphy, usually followed by other complications. The prognosis of these patients is not good, death occurring in less than two years after the diagnosis.
Cuvinte cheie: sclerosing peritonitis, peritoneal dialysis, complications.