Do you mean sclerosing peritonitis and if so what is the background context?
Dear Deborah
Yes,it is another name.
The patient has no other disease.
There is a series from the Mayo Clinic at the Journal of Clinical GAstroenterology and hepatology. Usually prednisone works fine, if not there are some second line treatments that work. Some cases respond to combination of steroids and tamoxifen
Are there any precipitating factors for the scerosing peritonitis/mesenteritis? That is has the patient been on peritoneal dilaysis or have they undergone surgery?
If there is bowel obstuction then surgery will be necessary. This can require a PEEL procedure. Use of an mTOR inhibitor such as Everolimus may also be useful.
Do you think it is necessary for the diagnosis a typical histology?
Sclerosin peritonitis is associated with background disease (such as ovarian techoma, dialysis, transplantation and peritoneal tuberculosis). Background diseases determine treatment choices. CT and/or MR Enterography could be useful for diagnosing of sclerosing peritonitis. However laparotomy or laparoscopic biopsy should be performed for typical histology and background disease.
Often the diagnosis is suspected and may be confirmed by characteristic appearances that are seen on imaging as per the following reference-
Screening for encapsulating peritoneal sclerosis in patients on peritoneal dialysis: role of CT scanning. Goodlad C. Tarzi R. Gedroyc W. Lim A. Moser S. Brown EA.Nephrology Dialysis Transplantation. 26(4):1374-9, 2011 Apr.
Biopsy usually just reveals fibrous tissue but is useful to confirm the diagnosis.
Our patient in has no specific histological findings (2 aspiration and one surgical), but the CT scan are very characteristics
If the patient has symptoms of bowel obstruction, I advise you to perform open surgery both to establish the diagnosis and to provide therapy.
We published a couple of cases of this about 15 years ago (Eur J Gastroent Hepatol, vol 11, pp 1323-9), but this was before we knew about IgG4 disease, and one of the cases was definitely due to IgG4, and we are still looking after him through a variety of different specialties. (The other was lost to follow-up, but was probably not IgG4.) Our cases reponded to immunosuppression, as is now well known with IgG4 disease, but certainly the IgG4 case has had many relapses and further organs affected despite continued treatment. You need a tissue diagnosis, but I would caution against surgery as the main modality of treatment. It may melt away on steroids, at least temporarily.
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