Peritoneal Diseases

  • Masaki IwaiEmail author
  • Yosuke Kunishi
  • Arief A. Suriawinata


The peritoneum is an organ of serosa with combined epithelial and mesenchymal features. It consists mainly of mesothelial cells arranged in a monolayer. Peritoneal disorders include primary or secondary tumors, benign or malignant tumors, and inflammatory disorders. Hence, they are not only of tuberculosis and sarcoidosis but also mesothelioma and carcinomatosis which can impair physiological functions [1] and produce massive ascites. Sclerosing encapsulating peritonitis leads to peritoneal fibrosis and obstruction of small intestine which mimics liver cirrhosis.


General considerations in peritoneal diseases Peritoneal tuberculosis Peritoneal sarcoidosis Sclerosing encapsulating peritonitis Peritoneal mesothelioma Peritoneal carcinomatosis 



Breast cancer-associated protein 1


Carcinogenic antigen-125


Carcinogenic antigen 19-9


18F-fluorodeoxyglucose positron emission tomography


Sclerosing encapsulating peritonitis


Tumor necrosis factor


Combination capsule of tegafur, gimeracil, and oteracil potassium


  1. 1.
    van Baal JOAM, Van de Vijver KK, Nieuwland R, van Noorden CJF, van Driel WJ, Sturk A, Kenter GG, Rikkert LG, Lok CAR. The histophysiology and pathophysiology of the peritoneum. Tissue Cell. 2017;49:95–105.CrossRefGoogle Scholar
  2. 2.
    Uzunkoy A, Harma M, Harma M. Diagnosis of abdominal tuberculosis: experience from 11 cases and review of the literature. World J Gastroenterol. 2004;10:3647–9.CrossRefGoogle Scholar
  3. 3.
    Sanai FM, Bzeizi KI. Systematic review: tuberculous peritonitis—presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther. 2005;22:685–700.CrossRefGoogle Scholar
  4. 4.
    Malik A, Saxena NC. Ultrasound in abdominal tuberculosis. Abdom Imaging. 2003;28:574–9.CrossRefGoogle Scholar
  5. 5.
    Sinan T, Sheikh M, Ramadan S, Sahwney S, Behbehani A. CT features in abdominal tuberculosis: 20 years-experience. BMC Med Imaging. 2002;2:3–16.CrossRefGoogle Scholar
  6. 6.
    Shimamoto H, Hamada K, Higuchi I, et al. Abdominal tuberculosis: peritoneal involvement shown by F-18 FDG PET. Clin Nucl Med. 2007;32:716–8.CrossRefGoogle Scholar
  7. 7.
    Riquelme A, Calvo M, Salech F, Valderrama S, Pattillo A, Arellano M, et al. Value of adenosine deaminase (ADA) in ascitic fluid for the diagnosis of tuberculous peritonitis: a meta-analysis. J Clin Gastroenterol. 2006;40:705–10.CrossRefGoogle Scholar
  8. 8.
    Henning H, Lightdale CJ, Look D. Color atlas of diagnostic laparoscopy. New York: Thieme Medical Publishers; 1994. p. 199–200.Google Scholar
  9. 9.
    Milingos S, Protopapas A, Papadimitriou C, Rodolakis A, Kallipolitis G, Skartados N, et al. Laparoscopy in the evaluation of women with unexplained ascites: an invaluable diagnostic tool. J Minim Invasive Gynecol. 2007;14:43–8.CrossRefGoogle Scholar
  10. 10.
    Jorge AD. Peritoneal tuberculosis. Endoscopy. 1984;16:10–2.CrossRefGoogle Scholar
  11. 11.
    Gezer NS, Başara I, Altay C, Harman M, Rocher L, Karabulut N, et al. Abdominal sarcoidosis: cross-sectional imaging findings. Diagn Interv Radiol. 2015;21:111–7.CrossRefGoogle Scholar
  12. 12.
    Kurdziel KA. The panda sign. Radiology. 2000;215:884–5.CrossRefGoogle Scholar
  13. 13.
    Kunishi Y, Yoshie K, Ota M, Kuboi Y, Kanno M, Tanaka S, et al. Peritoneal sarcoidosis: an unusual cause of ascites. Nihon Shokakibyo Gakkai Zasshi. 2016;113:143–51.Google Scholar
  14. 14.
    Warshauer DM, Molina PL, Hamman SM, Koehler RE, Paulson EK, Bechtold RE, et al. Nodular sarcoidosis of the liver and spleen: analysis of 32 cases. Radiology. 1995;195:757–62.CrossRefGoogle Scholar
  15. 15.
    Warshauer DM, Lee JKT. Imaging manifestations of abdominal sarcoidosis. Am J Roentgenol. 2004;182:15–28.CrossRefGoogle Scholar
  16. 16.
    Judson MA. Advances in the diagnosis and treatment of sarcoidosis. F1000Prime Rep. 2014;6:89–65.CrossRefGoogle Scholar
  17. 17.
    Dasilva V, Breuil V, Chevallier P, Euller-Ziegler L. Relapse of severe sarcoidosis with uncommon peritoneal location after TNF-alpha blockade. Efficacy of rituximab: report of a single case. Joint Bone Spine. 2010;77:82–3.CrossRefGoogle Scholar
  18. 18.
    Foo KT, Ng KC, Rauff A, Foong WC, Sinniah R. Unusual small intestinal obstruction in adolescent girls: the abdominal cocoon. Br J Surg. 1978;65:427–30.CrossRefGoogle Scholar
  19. 19.
    Akbulut S. Accurate definition and management of idiopathic sclerosing encapsulating peritonitis. World J Gastroenterol. 2015;21:675–87.CrossRefGoogle Scholar
  20. 20.
    Tannoury JN, Abboud BN. Idiopathic sclerosing encapsulating peritonitis: abdominal cocoon. World J Gastroenterol. 2012;18:1999–2004.CrossRefGoogle Scholar
  21. 21.
    Li N, Zhu W, Li Y, Gong J, Gu L, Li M, Cao L, Li J. Surgical treatment and perioperative management of idiopathic abdominal cocoon: single-center review of 65 cases. World J Surg. 2014;38:1860–7.CrossRefGoogle Scholar
  22. 22.
    George C, Al-Zwae K, Nair S, Cast JE. Computed tomography appearances of sclerosing encapsulating peritonitis. Clin Radiol. 2007;62:732–7.CrossRefGoogle Scholar
  23. 23.
    Honda K, Oda H. Pathology of encapsulating peritoneal sclerosis. Perit Dial Int. 2005;25(Suppl 4):S19–29.PubMedGoogle Scholar
  24. 24.
    Habib SM, Betjes MG, Fieren MW, Boeschoten EW, Abrahams AC, Boer WH, et al. Management of encapsulating peritoneal sclerosis: a guideline on optimal and uniform treatment. Neth J Med. 2011;69:500–7.PubMedGoogle Scholar
  25. 25.
    Yamamoto S, Sato Y, Takahashi T, Kobayashi T, Hatakeyama K. Sclerosing encapsulating peritonitis in two patients with liver cirrhosis. J Gastroenterol. 2004;39:172–5.CrossRefGoogle Scholar
  26. 26.
    Averbach AM, Sugarbaker PH. Peritoneal mesothelioma: treatment approach based on natural history. Cancer Treat Res. 1996;81:193–211.CrossRefGoogle Scholar
  27. 27.
    Friedman MT, Gentile P, Tarectecan A, Fuchs A. Malignant mesothelioma: immunohistochemistry and DNA ploidy analysis as methods to differentiate mesothelioma from benign reactive mesothelial cell proliferation and adenocarcinoma in pleural and peritoneal effusions. Arch Pathol Lab Med. 1996;120:959–66.PubMedGoogle Scholar
  28. 28.
    Pickhardt PJ, Bhalla S. Primary neoplasms of peritoneal and sub-peritoneal origin: CT findings. Radiographics. 2005;25:983–95.CrossRefGoogle Scholar
  29. 29.
    Park JY, Kim KW, Kwon HJ, Park MS, Kwon GY, Jun SY, et al. Peritoneal mesotheliomas: clinicopathologic features, CT findings, and differential diagnosis. AJR Am J Roentgenol. 2008;191:814–25.CrossRefGoogle Scholar
  30. 30.
    Søreide JA, Søreide K, Körner H, Søiland H, Greve OJ, GudLaugsson E. Benign peritoneal cystic mesothelioma. World J Surg. 2006;30:560–6.CrossRefGoogle Scholar
  31. 31.
    Nasu M, Emi M, Pastorino S, et al. High incidence of somatic BAP1 alterations in sporadic malignant mesothelioma. J Thorac Oncol. 2015;10(2):565–76.CrossRefGoogle Scholar
  32. 32.
    Cercek A, Zaderer M, Rimner A, et al. Confirmation of high prevalence of BAP1 inactivation in mesothelioma. J Clin Oncol. 2015;33(Suppl):Abstract 7564.CrossRefGoogle Scholar
  33. 33.
    Vogelzang NJ, Rusthoven JJ, Symanowski J, Denham C, Kaukel E, Ruffie P, et al. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol. 2003;21:2636–44.CrossRefGoogle Scholar
  34. 34.
    Hassan R, Alexander R, Antman K, Boffetta P, Churg A, Coit D, et al. Current treatment options and biology of peritoneal mesothelioma: meeting summary of the first NIH peritoneal mesothelioma conference. Ann Oncol. 2006;17:1615–9.CrossRefGoogle Scholar
  35. 35.
    Mohamed F, Sugarbaker PH. Peritoneal mesothelioma. Curr Treat Options Oncol. 2002;3:375–86.CrossRefGoogle Scholar
  36. 36.
    Baratti D, Kusamura S, Cabras AD, Dileo P, Laterza B, Deraco M. Diffuse malignant peritoneal mesothelioma: failure analysis following cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC). Ann Surg Oncol. 2009;16:463–72.CrossRefGoogle Scholar
  37. 37.
    Kim J, Bhagwandin S, Labow DM. Malignant peritoneal mesothelioma: a review. Ann Transl Med. 2017;5:236–46.CrossRefGoogle Scholar
  38. 38.
    Muntean V, Mihailov A, Iancu C, Toganel R, Fabian O, Domsa I, et al. Staging laparoscopy in gastric cancer. Accuracy and impact on therapy. J Gastrointestin Liver Dis. 2009;18:189–95.PubMedGoogle Scholar
  39. 39.
    del Castillo CF, Warshaw L. Peritoneal metastases in pancreatic carcinoma. Hepatogastroenterology. 1993;40:430–2.PubMedGoogle Scholar
  40. 40.
    Groutz A, Carmon E, Gat A. Peritoneal tuberculosis versus advanced ovarian cancer: a diagnostic dilemma. Obstet Gynecol. 1998;91:868.PubMedGoogle Scholar
  41. 41.
    Suzuki A, Kawano T, Takahashi N, Lee J, Nakagami Y, Miyagi E, et al. Value of 18F-FDG PET in the detection of peritoneal carcinomatosis. Eur J Nucl Med Mol Imaging. 2004;31:1413–20.CrossRefGoogle Scholar
  42. 42.
    Pomel C, Provencher D, Dauplat J, Gauthier P, Le Bouedec G, Drouin P, et al. Laparoscopic staging of early ovarian cancer. Gynecol Oncol. 1995;58:301–6.CrossRefGoogle Scholar
  43. 43.
    Sharma V, Rana SS, Ahmed SU, Guleria S, Sharma R, Gupta R. Endoscopic ultrasound fine-needle aspiration from ascites and peritoneal nodules: a scoping review. Endosc Ultrasound. 2017;6:382–8.CrossRefGoogle Scholar
  44. 44.
    Koizumi W, Tanabe S, Saigenji K, Ohtsu A, Boku N, Nagashima F, et al. Phase I/II study of S-1 combined with cisplatin in patients with advanced gastric cancer. Br J Cancer. 2003;89:2207–12.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Masaki Iwai
    • 1
    Email author
  • Yosuke Kunishi
    • 2
  • Arief A. Suriawinata
    • 3
  1. 1.KyotoJapan
  2. 2.TochigiJapan
  3. 3.New HampshireUSA

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