Sclerosing Encapsulating Peritonitis: A Surgical Challenge in Liver Transplantation

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-03-31 DOI:10.1016/j.transproceed.2025.02.036

Claudia Lorenzo , Gabriela Chullo , Emilio Domingo Tonina , Eva Rivas , Annabel Blasi , Marta Ubre , Gonzalo Crespo , Pablo Ruiz , Jordi Colmenero , Miguel Pera , Yiliam Fundora

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引用次数: 0

Abstract

Sclerosing Encapsulating Peritonitis (SEP) is a rare condition characterized by chronic inflammation of the peritoneum, of either idiopathic origin or sometimes due to local or systemic factors. The symptoms are often non-specific, and in many cases, the diagnosis is only made during laparotomy or laparoscopy. In severe cases, SEP can be a contraindication for liver transplantation because of the associated risk of surgical complications.

Method

To report on the incidence and management of SEP identified during liver transplantation at our center, and to document the associated Serious Adverse Events (SAEs).

Results

We present a series of 3 cases from 2022 to 2023, where SEP was diagnosed intraoperatively. These cases were marked by significant technical challenges, including extensive adhesions, dense fibrous encapsulations, and severe intraoperative hemorrhage necessitating blood transfusions. Despite these complexities, all transplants were successfully completed. One patient experienced a peak serum AST of 2000 U/L, and another had a bilirubin of 10 mg/dL, indicative of early graft dysfunction, both of which resolved within the first week. One patient required an emergency laparotomy due to hemorrhage. No additional severe complications were observed postoperatively. All patients are currently alive with functioning grafts and have been followed for at least 18 months.

Conclusions

A multidisciplinary approach and advanced surgical planning are crucial for successfully performing complex liver transplants in patients with SEP. Intraoperative recognition of SEP requires meticulous strategies to minimize blood loss and optimize hemostasis, while avoiding organ injuries, as these factors are critical for improving the survival outcomes in these patients.

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硬化性包膜性腹膜炎：肝移植手术的挑战。

硬化性包膜性腹膜炎（SEP）是一种罕见的疾病，其特征是腹膜的慢性炎症，要么是特发性的，要么是局部或全身因素引起的。症状通常是非特异性的，在许多情况下，诊断只能在剖腹手术或腹腔镜检查时做出。在严重的情况下，SEP可能是肝移植的禁忌症，因为相关的手术并发症的风险。方法：报告我院肝移植过程中发现的SEP的发生率和处理情况，并记录相关严重不良事件（SAEs）。结果：我们报告了从2022年到2023年的3例SEP在术中诊断的病例。这些病例的特点是重大的技术挑战，包括广泛的粘连，致密的纤维包封，以及严重的术中出血，需要输血。尽管存在这些复杂性，但所有移植手术都成功完成。一名患者的血清AST峰值为2000 U/L，另一名患者的胆红素峰值为10 mg/dL，表明早期移植物功能障碍，两者均在第一周内消退。一名患者因出血需要紧急剖腹手术。术后未见其他严重并发症。所有患者目前都存活，移植物功能正常，随访时间至少为18个月。结论：多学科的方法和先进的手术计划对于SEP患者成功进行复杂肝移植至关重要。术中识别SEP需要精心的策略，以减少失血和优化止血，同时避免器官损伤，因为这些因素对提高这些患者的生存结果至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.