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Review
. 2014 Aug 27:14:57.
doi: 10.1186/1471-2482-14-57.

Successful surgical approach for a patient with encapsulating peritoneal sclerosis after hyperthermic intraperitoneal chemotherapy: a case report and literature review

Katsushi Takebayashi, Hiromichi Sonoda  1 , Tomoharu Shimizu, Hiroyuki Ohta, Mitsuaki Ishida, Eiji Mekata, Yoshihiro Endo, Tohru Tani, Masaji Tani
Affiliations
Review

Successful surgical approach for a patient with encapsulating peritoneal sclerosis after hyperthermic intraperitoneal chemotherapy: a case report and literature review

Katsushi Takebayashi et al. BMC Surg. .

Abstract

Background: Encapsulating peritoneal sclerosis (EPS) is a rare surgical complication that can occur after intraperitoneal treatment. It is also a serious and potentially fatal complication of continuous ambulatory peritoneal dialysis. The present report describes a case of surgically treated EPS that probably occurred as a complication of hyperthermic intraperitonal chemotherapy (HIPEC).

Case presentation: A 39-year-old man required sigmoidectomy for serosal invasive advanced sigmoid colon cancer. HIPEC with oxaliplatin, 5-fluorouracil and mitomycin C were given as adjuvant therapy. Subsequently, intestinal obstruction developed at 15 months postoperatively, and the patient was hospitalized. Abdominal computed tomography showed a dilated small intestine enveloped by a thickened membrane. We found no evidence of peritoneal recurrence, but exploratory surgery revealed EPS, probably caused by HIPEC. We peeled the capsule off of the intestine. The patient's postoperative course was uneventful, and sufficient nutritional intake after surgery was noted. Seven months after surgery, he is well with no recurrence.

Conclusion: The surgical treatment via peritonectomy and enterolysis for postoperative EPS appears safe and effective. A diagnosis of EPS should be considered when intestinal obstruction does not show improvement with conservative treatment in patients who have undergone HIPEC, provided the possibility of peritoneal cancer recurrence is excluded.

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Figures

Figure 1
Figure 1
Abdominal computed tomography shows a dilated and filled small intestine enveloped by a thickened membrane ( arrow ).
Figure 2
Figure 2
Operative findings showed small intestine covered by white and fibrous membrane. The small intestine is partially covered by a white membrane and looks like a cocoon. The fibrous membrane is peeled off to release the small intestine.
Figure 3
Figure 3
Histological features of the case. (a), (b) Histological findings of the thickened membrane show proliferation of fibroconnective tissue and inflammatory infiltrates.
See this image and copyright information in PMC

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