Encapsulating peritoneal sclerosis(EPS) is a debilitating condition characterized by a fibrocollagenous membrane encasing the small intestine, resulting in recurrent small bowel obstructions. EPS is most commonly asso...Encapsulating peritoneal sclerosis(EPS) is a debilitating condition characterized by a fibrocollagenous membrane encasing the small intestine, resulting in recurrent small bowel obstructions. EPS is most commonly associated with long-term peritoneal dialysis, though medications, peritoneal infection, and systemic inflammatory disorders have been implicated. Many cases remain idiopathic. Diagnosis is often delayed given the rarity of the disorder combined with non-specific symptoms and laboratory findings. Although cross-sectional imaging with computed tomography of the abdomen can be suggestive of the disorder, many patients undergo exploratory laparotomy for diagnosis. Mortality approaches 50% one year after diagnosis. Treatment for EPS involves treating the underlying condition or eliminating possible inciting agents(i.e. peritoneal dialysis, medications, infections) and nutritional support, frequently with total parenteral nutrition. EPSspecific treatment depends on the disease stage. In the inflammatory stage, corticosteroids are the treatment of choice, while in the fibrotic stage, tamoxifen may be beneficial. In practice, distinguishing between stages may be difficult and both may be used. Surgical intervention, consisting of peritonectomy and enterolysis, is timeconsuming and high-risk and is reserved for situations in which conservative medical therapy fails in institutions with surgical expertise in this area. Herein we review the available literature of the etiology, pathogenesis, diagnosis, and treatment of this rare, but potentially devastating disease.展开更多
BACKGROUND Although minimally invasive surgery is becoming more commonly applied for ileostomy reversal(IR),there have been relatively few studies of IR for patients with Crohn's disease(CD).It is therefore import...BACKGROUND Although minimally invasive surgery is becoming more commonly applied for ileostomy reversal(IR),there have been relatively few studies of IR for patients with Crohn's disease(CD).It is therefore important to evaluate the potential benefits and risks of laparoscopy for patients with CD.AIM To compare the safety,feasibility,and short-term and long-term outcomes of laparoscopic IR(LIR)vs open IR(OIR)for the treatment of CD.METHODS The baseline characteristics,operative data,and short-term(30-d)and long-term outcomes of patients with CD who underwent LIR and OIR at our institution between January 2017 and January 2020 were retrieved from an electronic database and retrospectively reviewed.RESULTS Of the 60 patients enrolled in this study,LIR was performed for 48 and OIR for 12.There were no statistically significant differences in baseline characteristics,operation time,intraoperative blood loss,days to flatus and soft diet,postoperative complications,hospitalization time,readmission rate within 30 d,length of hospitalization,hospitalization costs,or reoperation rate after IR between the two groups.However,patients in the LIR group more frequently required lysis of adhesions as compared to those in the OIR group(87.5%vs 41.7%,respectively,P<0.05).Notably,following exclusion of patients who underwent enterectomy plus IR,OIR was more advantageous in terms of postoperative recovery of gastrointestinal function and hospitalization costs.CONCLUSION The safety and feasibility of LIR for the treatment of CD are comparable to those of OIR with no increase in intraoperative or postoperative complications.展开更多
文摘Encapsulating peritoneal sclerosis(EPS) is a debilitating condition characterized by a fibrocollagenous membrane encasing the small intestine, resulting in recurrent small bowel obstructions. EPS is most commonly associated with long-term peritoneal dialysis, though medications, peritoneal infection, and systemic inflammatory disorders have been implicated. Many cases remain idiopathic. Diagnosis is often delayed given the rarity of the disorder combined with non-specific symptoms and laboratory findings. Although cross-sectional imaging with computed tomography of the abdomen can be suggestive of the disorder, many patients undergo exploratory laparotomy for diagnosis. Mortality approaches 50% one year after diagnosis. Treatment for EPS involves treating the underlying condition or eliminating possible inciting agents(i.e. peritoneal dialysis, medications, infections) and nutritional support, frequently with total parenteral nutrition. EPSspecific treatment depends on the disease stage. In the inflammatory stage, corticosteroids are the treatment of choice, while in the fibrotic stage, tamoxifen may be beneficial. In practice, distinguishing between stages may be difficult and both may be used. Surgical intervention, consisting of peritonectomy and enterolysis, is timeconsuming and high-risk and is reserved for situations in which conservative medical therapy fails in institutions with surgical expertise in this area. Herein we review the available literature of the etiology, pathogenesis, diagnosis, and treatment of this rare, but potentially devastating disease.
基金The study protocol was approved by the Ethics Committee of the Shanghai Tenth People’s Hospital Affiliated to the Tongji University School of Medicine(approval No.21K53).
文摘BACKGROUND Although minimally invasive surgery is becoming more commonly applied for ileostomy reversal(IR),there have been relatively few studies of IR for patients with Crohn's disease(CD).It is therefore important to evaluate the potential benefits and risks of laparoscopy for patients with CD.AIM To compare the safety,feasibility,and short-term and long-term outcomes of laparoscopic IR(LIR)vs open IR(OIR)for the treatment of CD.METHODS The baseline characteristics,operative data,and short-term(30-d)and long-term outcomes of patients with CD who underwent LIR and OIR at our institution between January 2017 and January 2020 were retrieved from an electronic database and retrospectively reviewed.RESULTS Of the 60 patients enrolled in this study,LIR was performed for 48 and OIR for 12.There were no statistically significant differences in baseline characteristics,operation time,intraoperative blood loss,days to flatus and soft diet,postoperative complications,hospitalization time,readmission rate within 30 d,length of hospitalization,hospitalization costs,or reoperation rate after IR between the two groups.However,patients in the LIR group more frequently required lysis of adhesions as compared to those in the OIR group(87.5%vs 41.7%,respectively,P<0.05).Notably,following exclusion of patients who underwent enterectomy plus IR,OIR was more advantageous in terms of postoperative recovery of gastrointestinal function and hospitalization costs.CONCLUSION The safety and feasibility of LIR for the treatment of CD are comparable to those of OIR with no increase in intraoperative or postoperative complications.