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PloS One 2014Peritoneal dialysis (PD) is complicated by peritonitis episodes that cause loss of mesothelium and eventually sclerosing peritonitis. An improved understanding of the...
Peritoneal dialysis (PD) is complicated by peritonitis episodes that cause loss of mesothelium and eventually sclerosing peritonitis. An improved understanding of the molecular contributors to peritoneal injury and defense may increase the therapeutic armamentarium to optimize peritoneal defenses while minimizing peritoneal injury. There is no information on the expression and function of the cytokine TWEAK and its receptor Fn14 during peritoneal injury. Fn14 expression and soluble TWEAK levels were measured in human PD peritoneal effluent cells or fluids with or without peritonitis. Fn14 expression was also analyzed in peritoneal biopsies from PD patients. Actions of intraperitoneal TWEAK were studied in mice in vivo. sTWEAK levels were increased in peritoneal effluent in PD peritonitis. Effluent sTWEAK levels correlated with the number of peritoneal macrophages (r=0.491, p=0.002). Potential TWEAK targets that express the receptor Fn14 include mesothelial cells and macrophages, as demonstrated by flow cytometry of peritoneal effluents and by analysis of peritoneal biopsies. Peritoneal biopsy Fn14 correlated with mesothelial injury, fibrosis and inflammation, suggesting a potential deleterious effect of TWEAK/Fn14. In this regard, intraperitoneal TWEAK administration to mice promoted peritoneal inflammation characterized by increased peritoneal effluent MCP-1, Fn14 and Gr1+ macrophages, increased mesothelial Fn14, MCP-1 and CCL21 expression and submesothelial tissue macrophage recruitment. Taken together these data suggest that the TWEAK/Fn14 system may promote inflammation and tissue injury during peritonitis and PD.
Topics: Adult; Aged; Aged, 80 and over; Animals; Case-Control Studies; Cells, Cultured; Chemokines; Cytokine TWEAK; Female; Gene Expression; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Inflammation Mediators; Kidney Failure, Chronic; Macrophages, Peritoneal; Male; Mice, Inbred C57BL; Middle Aged; Peritoneal Dialysis; Peritonitis; Receptors, Tumor Necrosis Factor; TWEAK Receptor; Tumor Necrosis Factors
PubMed: 24599047
DOI: 10.1371/journal.pone.0090399 -
Acta Medica Portuguesa 2009The Sclerosing Mesenteritis is a rare idiopathic disease. It represents the final stadium of progression of the chronic inflammatory illnesses of the intestinal...
The Sclerosing Mesenteritis is a rare idiopathic disease. It represents the final stadium of progression of the chronic inflammatory illnesses of the intestinal mesentery, with predominance of fibrosis. The clinical manifestations are varied and unspecific. Diagnosis, that demands high degree of suspicion, can be presumed for imaging study, that discloses heterogeneous mass with tumor-like appearance, and confirmed on the basis of anatomo-pathological examination. The treatment is empirical and the prognostic is habitually favourable, over all in initial stadiums of the illness, being in a minority fatal. The authors describe the clinical case of a 50 years-old woman, admitted in the hospital for abdominal pain, ascitis and fever and that by radiological suspicion of peritoneal carcinomatosis and negative complementary study for primitive neoplasm, was submitted to an exploring laparotomy. Observed accented thickening of the mesentery that formed an extensive adherent conglomerate of bowel loops, whose biopsy had disclosed to be a sclerosing mesenteritis. Was verified an irrelevant answer to the treatment and an unfavourable, lethal, clinical course. The authors provide a literature review concerning the most relevant aspects of this disease.
Topics: Fatal Outcome; Female; Humans; Middle Aged; Panniculitis, Peritoneal
PubMed: 20350470
DOI: No ID Found -
The Journal of International Medical... Aug 2020Sclerosing encapsulating peritonitis (SEP) is a disease that is rarely encountered clinically. Preoperative diagnosis of SEP can be difficult. However, with imaging... (Review)
Review
Sclerosing encapsulating peritonitis (SEP) is a disease that is rarely encountered clinically. Preoperative diagnosis of SEP can be difficult. However, with imaging technology, such as computed tomography (CT), this condition can be diagnosed without surgery and pathological analysis. SEP is characterized by small intestine being partially or completely encased by a layer of a thick grayish-white fibrocollagenous membrane similar to a cocoon. The most common symptoms of SEP are abdominal pain, nausea, and vomiting. SEP often leads to intestinal obstruction. Our hospital treated three emergency patients who complained of acute or chronic abdominal pain. CT showed "cauliflower sign" in two cases. The three patients were diagnosed with SEP intraoperatively. In a female patient with ascites, the situation was extremely serious, and this condition had not been reported in detail previously. Fortunately, all patients were discharged without complications. We should pay special attention to patients with SEP who have ascites, which indicates a serious situation.
Topics: Ascites; Female; Humans; Intestinal Obstruction; Intestine, Small; Peritonitis; Tomography, X-Ray Computed
PubMed: 32811273
DOI: 10.1177/0300060520949104 -
Ulusal Cerrahi Dergisi 2015Sclerosing encapsulating peritonitis (SEP)/abdominal cocoon syndrome is a rare condition that is generally identified in young females. The exact cause is still unknown....
Sclerosing encapsulating peritonitis (SEP)/abdominal cocoon syndrome is a rare condition that is generally identified in young females. The exact cause is still unknown. Timely and accurate imaging and diagnosis play a critical role for morbidity and mortality. It is usually diagnosed during surgery. The initial treatment should be conservative, and aggressive surgical approach should be avoided as much as possible. Herein, we aimed to review the clinical features of SEP based on a patient who underwent surgery in our clinic.
PubMed: 26668535
DOI: 10.5152/UCD.2015.2786 -
International Journal of Surgery Case... 2015Abdominal cocoon or sclerosing peritonitis refers to a rare cause of intestinal obstruction due to formation of a membrane encasing the bowel. We report a case of...
Abdominal cocoon or sclerosing peritonitis refers to a rare cause of intestinal obstruction due to formation of a membrane encasing the bowel. We report a case of abdominal cocoon post blunt trauma abdomen. The patient presented with a history of subacute intestinal obstruction and a mobile abdomen lump. Abdominal cocoon was diagnosed on computed tomography. He underwent adhesiolysis with excision of membrane.
PubMed: 25590647
DOI: 10.1016/j.ijscr.2014.10.081 -
International Journal of Surgery Case... Oct 2023Idiopathic Sclerosing Encapsulating Peritonitis (ISEP) is an uncommon condition of intestinal bowel obstruction due to encapsulation of the abdominal organs in a thick...
INTRODUCTION AND IMPORTANCE
Idiopathic Sclerosing Encapsulating Peritonitis (ISEP) is an uncommon condition of intestinal bowel obstruction due to encapsulation of the abdominal organs in a thick fibro-collagenous membrane. The case presented here describes the emergency acute presentation of septic peritonitis discovered intraoperatively upon laparotomy.
CASE PRESENTATION
A middle-aged woman was admitted to the emergency department and presented with generalized colicky abdominal pain associated with repetitive vomiting, abdominal distention, and absolute constipation. A digital rectal examination revealed an empty rectum and a bilious output was observed in the nasogastric tube. Abdominal X-Ray demonstrated multiple air-fluid levels with no air under the diaphragm. The patient was treated with fluid therapy and antibiotics intravenously (IV).
CLINICAL DISCUSSION
The clinical impression of acute-on-chronic intestinal obstruction with peritonitis and the possibility of bowel strangulation was made. Emergency exploratory laparotomy revealed viable bowel loops encased in thickened fibrous capsules covering the entire abdominal viscera establishing the existence of ISEP. The fibrous capsule layer was excised out in small pieces from all the abdominal organs excluding stomach through extensive adhesiolysis without loop resection.
CONCLUSION
The emergency presentation of acute peritonitis observed in this study could only be identified through diagnostic laparoscopy and differential radiological imaging techniques. Further, better reporting of such rare cases may help clinicians understand the different clinical features that could indicate the occurrence of ISEP.
PubMed: 37717368
DOI: 10.1016/j.ijscr.2023.108837 -
Journal of Surgical Case Reports Nov 2023A man in his 70s presented to the emergency department with painless obstructive jaundice. Initial blood test results show a predominantly cholestatic picture with...
A man in his 70s presented to the emergency department with painless obstructive jaundice. Initial blood test results show a predominantly cholestatic picture with elevated tumour markers, and imaging findings are concerning for a pancreatic head neoplasm or cholangiocarcinoma with involvement of the entire common bile duct. The patient underwent staging laparoscopy and biopsies including peritoneal washing, but did not identify any features of malignancy. Immunoglobulin G and immunoglobulin G4 testing were subsequently tested and shown to be elevated. The provisional diagnosis of immunoglobulin G4-related sclerosing cholangitis was made, and steroid treatment was empirically started. Treatment with steroids was successful, with complete resolution of symptoms and abnormal imaging findings and near complete resolution of liver function test results after 1 month.
PubMed: 38034909
DOI: 10.1093/jscr/rjad621 -
Frontline Gastroenterology 2021A 60-year-old male liver transplant recipient presented to his local hospital with left-sided partial seizures following a few days of generalised headache. He had...
A 60-year-old male liver transplant recipient presented to his local hospital with left-sided partial seizures following a few days of generalised headache. He had undergone transplantation for primary sclerosing cholangitis 4 years earlier and maintained on tacrolimus monotherapy immunosuppression. He had no other comorbidities of note and worked as an arable farmer. At last follow-up, he had been well with preserved graft function and afternoon trough tacrolimus levels of 2-4 ng/mL. Over the preceding 4 weeks, he had been investigated locally for weight loss and a productive cough, where CT of the chest showed calcified mediastinal and hilar lymphadenopathy. Bronchoscopy samples were negative for acid-fast bacilli and he had been empirically treated for assumed community acquired pneumonia. Initial seizure management was with intravenous diazepam and phenytoin. On transfer to our centre, he was noted to be dysarthric with persisting 4/5 left upper limb weakness and nystagmus to all extremes of gaze. Blood tests were significant for mild anaemia (haemoglobin 90 g/L) and elevated C reactive protein (134 mg/L). The peripheral white cell count was 6.6×10/L. Biochemical liver graft function was normal and the 8am trough tacrolimus level was low at 2 ng/mL. CT head revealed bilateral ring enhancing cerebral lesions with surrounding vasogenic oedema but no mass effect. On MRI these exhibited restricted diffusion and marked perilesional oedema, suggestive of infection. Cerebrospinal fluid (CSF) analysis was as follows: white cell count <1/mm, protein 0.57 g/L (normal range <45 g/L) and glucose 3 mmol/L (paired plasma glucose 4.8 mmol/L). Testing for virological causes via PCR, toxoplasma serology and blood and CSF cultures, including for tuberculosis, were all negative. Whole body positron emission tomography-CT demonstrated uptake in numerous peritoneal and intramuscular lesions as well as right-sided cervical lymphadenopathy, which was sampled with fine needle aspiration. Microscopy revealed a filamentous, beading and branching Gram-positive bacillus that was partially acid-fast, subsequently speciated as .
PubMed: 33489071
DOI: 10.1136/flgastro-2019-101221 -
BMC Veterinary Research Nov 2022Sclerosing encapsulating peritonitis (SEP) is a rare clinical syndrome characterised by fibrosis and thickening of the peritoneum with massive adhesions of the abdominal...
BACKGROUND
Sclerosing encapsulating peritonitis (SEP) is a rare clinical syndrome characterised by fibrosis and thickening of the peritoneum with massive adhesions of the abdominal organs. In humans, abdominal tumours, such as pancreatic adenocarcinoma, can be underlying diseases of SEP. This report describes a case of SEP in a dog with pancreatic ductal adenocarcinoma.
CASE PRESENTATION
An 11-year-old male neutered French Bulldog presented with chronic vomiting. Ultrasonography revealed a mass in the centre of the abdomen. A small amount of ascites, interpreted as modified transudate, was present in the abdominal cavity. Computed tomography (CT) revealed peritoneal effusion with a thickened peritonium. Laparoscopy revealed a large nodular lesion occupying the central portion of the abdomen, continuous with the falciform ligament. Histological examination of the biopsy specimens of the mass, abdominal wall, and gastric peritoneum revealed marked fibroplasia with mild lymphoplasmacytic infiltrates. Based on these results, a tentative diagnosis of early stage sclerosing encapsulating peritonitis (SEP) was made. Prednisolone and tamoxifen were administered with the expectation of ameliorating SEP, however, the dog died 61 days post diagnosis. At autopsy, the intestinal loop and mesentery were encased in the fibrous membrane, which is a typical finding in SEP. Histopathology and immunohistochemistry of the samples obtained at autopsy supported the diagnosis of pancreatic ductal adenocarcinoma with peritoneal dissemination and distant metastasis with desmoplasia. The unexpectedly hardened skin, where previously laparoscopic ports were inserted, histologically contained the same carcinoma cells with desmoplasia.
CONCLUSIONS
To the best of our knowledge, this is the first report of canine SEP with pancreatic ductal adenocarcinoma that also caused metastasis to port insertion sites as well as distant organs.
Topics: Humans; Male; Dogs; Animals; Peritonitis; Adenocarcinoma; Pancreatic Neoplasms; Ascitic Fluid; Dog Diseases
PubMed: 36324126
DOI: 10.1186/s12917-022-03485-0 -
Cureus Feb 2023Primary sclerosing cholangitis (PSC) is a rare, chronic, and progressive disease of the liver characterized by cholestasis due to multifocal bile duct strictures. PSC...
Primary sclerosing cholangitis (PSC) is a rare, chronic, and progressive disease of the liver characterized by cholestasis due to multifocal bile duct strictures. PSC can lead to liver fibrosis, and in 10-20% of cases, it leads to cholangiocarcinoma and end-stage liver disease. However, the pathogenesis of the disease is not clearly understood. For the diagnosis of PSC, both imaging and liver biopsy can be used. No medical treatment has managed to prevent the progression of the disease. Consequently, in the case of late-stage disease, liver transplantation is considered the best treatment option. PSC may lead to different complications including bacterial cholangitis, cholangiocarcinoma, and cirrhosis. Nevertheless, to our knowledge, there are no reports of granulomatous peritonitis secondary to PSC. Granulomatous peritonitis may be a result of infectious, malignant, and idiopathic inflammatory diseases. It is also considered a rare postoperative complication, due to cornstarch from surgical glove powder, in laparoscopic procedures. Here, we report the case of a 39-year-old male patient with PSC, in which cholangiocarcinoma and peritoneal carcinomatosis were clinically suspected. Despite that, histological findings and staining methods of the surgically removed peritoneal masses demonstrated granulomatous peritonitis.
PubMed: 36909068
DOI: 10.7759/cureus.34738