Sclerosing peritonitis is a condition characterized by chronic fibrotic thickening of the peritoneum,
with a broad spectrum of gastrointestinal symptoms,
which in severe cases causes encapsulation of the small bowel loops,
known as sclerosing encapsulating peritonitis or abdominal cocoon.
It is a rare entity,
with a high morbidity and mortality.
It is important to consider this pathology in patients at risk,
to detect the earliest signs,
and to be able to carry out the appropriate treatment.
Of uncertain etiology,
it is believed that chronic irritation of the peritoneum is its cause.
It can be classified idiopathically or secondarily.
Within the first,
it may be found in young women from tropical or subtropical countries [1].
The reason for this prevalence remains unknown.
Among secondary causes,
it can be related to continuous ambulatory peritoneal dialysis (CAPD),
fungal infections,
tuberculosis,
prolonged use of beta-blocker practolol,
ventriculoperitoneal and peritoneovenous shunts,
orthotopic liver transplant,
abdominal surgery,
sarcoidosis,
systemic lupus erythematosus,
familial Mediterranean fever,
deficiency of the S protein and luteinized-ovarian tecoma [2-3].
CAPD is one of the most frequent causes,
with prevalence between 0.4% and 8.9%,
and the risk of development after 5 years of peritoneal dialysis varies between 0.6% and 6.6% [4].
It can also show up many years after cessation,
so it is of the utmost importance to be clinically aware.
In the histology of the membranes,
we find fibrocollagenous tissue with nonspecific inflammatory component.
These changes that are characteristic of sclerosing peritonitis,
are not specific and overlap with membrane changes that occur with ultrafiltration failure and infectious peritonitis in long-term peritoneal dialysis [4].
Clinically,
its presentation can be asymptomatic,
or with nonspecific symptoms such as abdominal pain and distension,
nausea,
vomiting,
palpable mass,
anorexia,
weight loss and recurrent episodes of small-bowel obstruction.
These can lead to malnutrition,
sepsis and death.
Loss of ultrafiltration and bloody dialysis effluent is seen in dialyzed patients [4].
Elevated C-reactive protein,
anemia and hypoalbuminemia may be found [1],
but there are neither specific blood markers nor reliable screening methods.
Diagnosis is based on clinical suspicion and confirmed by imaging methods or surgically.
The differential diagnosis related to peritoneal calcifications includes tuberculosis,
amyloidosis,
hyperparathyroidism,
pseudomyxoma peritonei and peritoneal carcinomatosis.
Among small bowel obstruction,
the internal hernia must be considered as it can also produce abnormal clustering of small bowel loops [3].
The treatment is related to its cause,
including adhesiolysis surgery or immunosuppression with corticosteroids,
tamoxifen or sirolimus,
and an adequate nutrition.
No surgical treatment is required if it is asymptomatic [5].
If it is associated with CAPD,
it must be suspended and the patient must be transferred to hemodialysis [4].