Diagnosis and treatment of abdominal cocoon: a report of 24 cases

Sclerosing encapsulating peritonitis after living donor liver transplantation: a case successfully treated with tamoxifen: report of a case

Sclerosing encapsulating peritonitis (SEP) is a rare cause of bowel obstruction. It is difficult to diagnose and the prognosis is poor. This report describes a case of SEP after living donor liver transplantation that was successfully treated with tamoxifen. A 56-year-old male, that had received a liver transplant for hepatitis C virus-related hepatocellular carcinoma 5 years earlier, was admitted with continuous abdominal pain and nausea. He had increased C-reactive protein levels and white blood cell count, and underwent laparotomy 5 days after hospitalization. The surgical findings showed ascites and SEP of the small bowel. An attempt to peel off the adhesions was stopped because there was a strong risk of intestinal tract damage. Tamoxifen treatment was initiated for SEP after surgery. The patient's symptoms gradually improved and he was able to resume feeding. He had been symptom-free for over 3 years at the last follow-up.

Idiopathic sclerosing encapsulating peritonitis: a case in an adolescent girl

Encapsulating peritonitis or "abdominal cocoon" is characterised by part or all of the digestive tube being encased in a thick membrane forming a sort of "cocoon". In addition to secondary forms related to peritoneal dialysis or those with drug related, inflammatory or tumour aetiologies, rare idiopathic forms have been described. We report here a case of an idiopathic form in a 15-year-old adolescent girl.

Idiopathic sclerosing encapsulating peritonitis: Abdominal cocoon

Abdominal cocoon, the idiopathic form of sclerosing encapsulating peritonitis, is a rare condition of unknown etiology that results in an intestinal obstruction due to total or partial encapsulation of the small bowel by a fibrocollagenous membrane. Preoperative diagnosis requires a high index of clinical suspicion. The early clinical features are nonspecific, are often not recognized and it is difficult to make a definite pre-operative diagnosis. Clinical suspicion may be generated by the recurrent episodes of small intestinal obstruction combined with relevant imaging findings and lack of other plausible etiologies. The radiological diagnosis of abdominal cocoon may now be confidently made on computed tomography scan. Surgery is important in the management of this disease. Careful dissection and excision of the thick sac with the release of the small intestine leads to complete recovery in the vast majority of cases.

A rare cause of small bowel obstruction: Abdominal cocoon

INTRODUCTION

The clinical manifestations of abdominal 'cocoon' are non-specific and hence its diagnosis is rarely made preoperatively and the management is often delayed. Surgery remains the main stay of treatment with satisfactory outcome and comprises excision of the fibrous membrane, meticulous adhesionolysis and release of the entrapped small bowel.

PRESENTATION OF CASE

A 45-year-old male patient presented with 6-month history of progressive subacute small bowel obstruction. After initial radiological investigations, he underwent diagnostic laparoscopy and was misdiagnosed as abdominal tuberculosis. He was started on anti-tuberculous therapy, but exploratory laparotomy was carried out after failure to respond to anti-tuberculous therapy. At laparotomy, the abdominal 'cocoon' which was encapsulating the entire small bowel was excised, and the adhesions were carefully lysed. The patient remained well and without recurrence at 1-year follow-up.

DISCUSSION

Abdominal 'cocoon' is a rare cause of subacute, acute and chronic small bowel obstruction. Its diagnosis is rarely made preoperatively.

CONCLUSION

Abdominal 'cocoon' should be thought of as a rare cause of small bowel obstruction. It may be mistaken with abdominal tuberculosis. Surgery remains the mainstay of curative treatment.

Abdominal cocoon: a unique presentation in an immunodeficient infant

Abdominal cocoon is a rare disorder that may pose a diagnostic conundrum in patients presenting with intermittent symptoms of small bowel obstruction. We describe the imaging findings of a unique case of abdominal cocoon that presented in infancy.

An unusual case in surgical emergency: Abdominal cocoon and its laparoscopic management

Small bowel obstruction associated with abdominal cocoon (AC) is a rarely encountered surgical emergency. This condition is characterised by a thick fibrous membrane which encases the small bowel partially or completely. It is usually difficult to be able to make a definitive diagnosis in the presence of obscure clinical and radiological findings. Diagnosis is usually made at laparotomy when the encasement of the small bowel within a cocoon-like sac is visualised. Here, we report on a 29-year-old male patient who presented with acute small bowel obstruction and was eventually diagnosed with AC at laparoscopy. In this case, laparoscopic excision of the fibrous sac and extensive adhesiolysis resulted in complete recovery. Although rare, the diagnosis of AC should be kept in cases of patients with intestinal obstruction combined with relevant imaging findings. Laparoscopy should also be considered for the management of this condition in suitable patients.

Post-traumatic intra-cocoon mesenteric tear: a case report

Sclerosing peritonitis, more commonly called abdominal cocoon, is a rare intra-peritoneal disease that is characterized by complete or partial encapsulation of the small intestine by a thick collagenous membrane. This disease mostly presents in the form of small bowel obstruction, however in our case the patient presented with intra-cocoon bleeding following a motor vehicle accident.

A problem encapsulated - role of CT

Sclerosing encapsulating peritonitis (SEP) is a rare but serious complication of abdominal surgery, recurrent peritonitis, and continuous ambulatory peritoneal dialysis with a high morbidity and mortality. The etiology of this condition is largely unknown. Diagnosis is usually established at laparotomy in patients with recurrent attacks of non-strangulating, small bowel obstruction. We report a case of a patient who presented with intestinal obstruction and who showed typical CT findings of SEP which was diagnosed pre-operatively on a CT scan and confirmed at surgery. The interest of this case lies in its rarity and difficult pre-operative diagnosis.