Sclerosing encapsulating peritonitis after intraperitoneal use of povidone iodine

Background: The use of intraperitoneal povidone iodine as an agent fur peritoneal lavage in colorectal surgery is controversial. Although it possesses a wide range of antimicrobial activity and is rapidly lethal to dissociated colorectal cancer cells in vitro, concern about its potential toxicity remains. Methods: Two cases of sclerosing encapsulating peritonitis (SEP) following elective colorectal surgery are presented. In each case the peritoneal cavity was lavaged with an aqueous povidone iodine solution. The surgical literature on the intraperitoneal use of povidone iodine is reviewed. Results: Significant morbidity resulted from the postoperative development of SEP in both of our patients. In one patient an ileo-anal pouch could not be fashioned following an initial colectomy, and in the second patient a small-bowel obstruction required a laparotomy and a period of intravenous nutrition before an oral diet could be tolerated. Conclusion: The use of povidone iodine for peritoneal lavage in colorectal surgery is to be cautioned against in concentrations of > 1%.