SCLEROSING ENCAPSULATING PERITONITIS - EARLY AND LATE RESULTS OF SURGICAL-MANAGEMENT IN 32 CASES

Objective: To propose guidelines for treatment based on the study of e arly and late outcome after Various surgical procedures for sclerosing encapsulating peritonitis (SEP). Primary Background Data: SEP is rare . The main complication is intestinal obstruction. Ideal treatment is resection of the membrane, whenever possible. Mortality and morbidity, however, have not been well analyzed. Methods: The case records and h istopathological reports of 32 operated cases of SEP (18 centers durin g 16 years) were retrospectively studied. Patients underwent four type s of procedures: group 1 (n = 5), membrane resection; group 2 (n = 12) , enterolysis with partial excision of the membrane; group 3 (n = 7), intestinal resection, and group 4 (n = 8), exploratory laparotomy only . Five cases were considered as idiopathic. Medical and surgical antec edent history for the 27 other cases (6 patients had associations) inc luded laparotomy for carcinoma (n = 14) or benign disorders (n = 5), b eta-blocker treatment (n = 4), cirrhotic ascites (n = 4), generalized peritonitis (n = 3) and continuous ambulatory peritoneal dialysis (n = 3). Indications for operation included subacute (n = 22) or acute int estinal obstruction (n = 6), abdominal mass (n = 8), other clinical pr esentations (n = 4) and asymptomatic SEP discovered during surgery for portacaval shunt (n = 1). Seven patients had two associated clinical presentations. All cirrhotic patients with ascites and the asymptomati c patient were in group 4. None of the imaging techniques (plain radio grams, barium follow-through, sonograms and CT scans) were formally co ntributive to the preoperative diagnosis of SEP. Results: In group 1, both complicated patients, one with an inadvertent intraoperative inte stinal wound, the other with a postoperative intestinal leak, healed u neventfully. In group 2, 4 inadvertent intraoperative intestinal wound s led to 4 postoperative leaks with 3 consequent deaths. One further p atient died of persistent intestinal obstruction. In group 3, 1 inadve rtent intestinal intraoperative wound healed uneventfully and 2 deaths , one due to persistent intestinal obstruction associated with anastom otic leakage and the other due to ventricular fibrillation, were noted . In group 4, there were no intraoperative wounds, no postoperative mo rbidity or deaths. The median follow-up was 49.5 months (range 4-142 m onths). Seven patients (1 or 2 in each group) experienced transient ep isodes of subacute intestinal obstruction between I month and 6 years after discharge, none of which required a repeat operation. Eight pati ents (in all groups) died of their initial cancer between 4 and 75 mon ths after discharge. Conclusions: Our results suggest that: (1)resecti on of the membrane should be attempted when feasible; (2) in case of i nadvertent intestinal wound(s), the most proximal one should be brough t out as a stoma, and partial resections should not be anastomosed pri marily, but (3) no surgical treatment is required in ascites, asymptom atic SEP or subacute intestinal obstruction.