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Zhang J, Hsieh Y, Zheng K, Xu J. Managing abdominal cocoon syndrome complicated by intestinal necrosis and unexpected amelioration of depression after surgery: a case report. J Med Case Rep 2024; 18:322. [PMID: 38970114 PMCID: PMC11227164 DOI: 10.1186/s13256-024-04650-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/24/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Abdominal cocoon is a very uncommon yet dangerous cause of intestinal obstruction. CASE PRESENTATION We present a case of a 62-year-old Asian male patient with a history of depression who exhibited an idiopathic abdominal cocoon complicated by necrosis. Upon laparotomy investigation, nearly the entire small intestine was enveloped in a thick membrane resembling a cocoon, and it was discovered that he lacked a greater omentum. The patient recovered well and was discharged on an oral diet on the 20th day following surgery. During the 3-month follow-up, the patient was asymptomatic, even gaining 10 kg in weight, and noted that his depression had improved. CONCLUSIONS Small bowel obstruction presents with nonspecific symptoms, posing challenges in differential diagnosis. Contrast-enhanced computed tomography is recommended since it facilitates precise preoperative assessment, optimizing surgical planning and reducing postoperative complications. Remarkably, cessation of antidepressant medication post-surgery hints at a potential correlation between omental deficit, gut microbiota alterations, and depressive symptoms.
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Affiliation(s)
- Judong Zhang
- Department of General Surgery, Tianjin Union Medical Center, The Affiliated Hospital of Nankai University, Tianjin, 300121, China
- Tianjin Key Laboratory of General Surgery in Construction, Tianjin Union Medical Center, Tianjin, 300121, China
| | - Yifang Hsieh
- Department of General Surgery, Tianjin Union Medical Center, The Affiliated Hospital of Nankai University, Tianjin, 300121, China
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Kunming Zheng
- Department of General Surgery, Tianjin Union Medical Center, The Affiliated Hospital of Nankai University, Tianjin, 300121, China
- Tianjin Key Laboratory of General Surgery in Construction, Tianjin Union Medical Center, Tianjin, 300121, China
| | - Jing Xu
- Department of General Surgery, Tianjin Union Medical Center, The Affiliated Hospital of Nankai University, Tianjin, 300121, China.
- Tianjin Key Laboratory of General Surgery in Construction, Tianjin Union Medical Center, Tianjin, 300121, China.
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2
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Abera MT, Abdela AF, Adela AY, Annose RT, Kebede AG. Sclerosing encapsulating peritonitis: A rare cause of intestinal obstruction in 2 patients. Radiol Case Rep 2024; 19:2477-2482. [PMID: 38577128 PMCID: PMC10992281 DOI: 10.1016/j.radcr.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/06/2024] [Accepted: 03/09/2024] [Indexed: 04/06/2024] Open
Abstract
Sclerosing encapsulating peritonitis is a very rare cause of intestinal obstruction. It usually follows peritoneal dialysis. The idiopathic form is also called abdominal cocoon and is more common in tropical and subtropical regions. We hereby present the clinical histories and imaging findings of 2 confirmed cases of sclerosing encapsulating peritonitis who presented with chronic symptoms of bowel obstruction.
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Affiliation(s)
| | - Abubeker Fedlu Abdela
- Department of Radiology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Rodas Temesgen Annose
- Department of Radiology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Assefa Getachew Kebede
- Department of Radiology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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3
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Vipudhamorn W, Juthasilaparut T, Sutharat P, Sanmee S, Supatrakul E. Abdominal cocoon syndrome-a rare culprit behind small bowel ischemia and obstruction: Three case reports. World J Gastrointest Surg 2024; 16:955-965. [PMID: 38577091 PMCID: PMC10989339 DOI: 10.4240/wjgs.v16.i3.955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/16/2023] [Accepted: 02/06/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Abdominal cocoon syndrome (ACS) represents a category within sclerosing encapsulating peritonitis, characterized by the encapsulation of internal organs with a fibrous, cocoon-like membrane of unknown origin, resulting in bowel obstruction and ischemia. Diagnosing this condition before surgery poses a challenge, often requiring confirmation during laparotomy. In this context, we depict three instances of ACS: One linked to intestinal obstruction, the second exclusively manifesting as intestinal ischemia without any obstruction, and the final case involving a discrepancy between the radiologist and the surgeon. CASE SUMMARY Three male patients, aged 53, 58, and 61 originating from Northern Thailand, arrived at our medical facility complaining of abdominal pain without any prior surgeries. Their vital signs remained stable during the assessment. The diagnosis of abdominal cocoon was confirmed through abdominal computed tomography (CT) before surgery. In the first case, the CT scan revealed capsules around the small bowel loops, showing no enhancement, along with mesenteric congestion affecting both small and large bowel loops, without a clear obstruction. The second case showed intestinal obstruction due to an encapsulated capsule on the CT scan. In the final case, a patient presented with recurring abdominal pain. Initially, the radiologist suspected enteritis as the cause after the CT scan. However, a detailed review led the surgeon to suspect encapsulating peritoneal sclerosis (ACS) and subsequently perform surgery. The surgical procedure involved complete removal of the encapsulating structure, resection of a portion of the small bowel, and end-to-end anastomosis. No complications occurred during surgery, and the patients had a smooth recovery after surgery, eventually discharged in good health. The histopathological examination of the fibrous membrane (cocoon) across all cases consistently revealed the presence of fibro-collagenous tissue, without any indications of malignancy. CONCLUSION Individuals diagnosed with abdominal cocoons commonly manifest vague symptoms of abdominal discomfort. An elevated degree of clinical suspicion, combined with the application of appropriate radiological evaluations, markedly improves the probability of identifying the abdominal cocoon before surgical intervention. In cases of complete bowel obstruction or ischemia, the established norm is the comprehensive removal of the peritoneal sac as part of standard care. Resection with intestinal anastomosis is advised solely when ischemia and gangrene have been confirmed.
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Affiliation(s)
- Witcha Vipudhamorn
- Department of Colorectal Surgery, Chiang Mai University, Chiang Mai 50200, Thailand
| | | | - Pawit Sutharat
- Department of Colorectal Surgery, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Suwan Sanmee
- Department of Colorectal Surgery, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Ekkarin Supatrakul
- Department of Colorectal Surgery, Chiang Mai University, Chiang Mai 50200, Thailand
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4
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Tajaddini A, Fallahi M, Haghshenas H, Nourmohammadi S, Ghahramani L, Shahriarirad R. Primary abdominal cocoon syndrome manifesting with Chilaiditi syndrome and intestinal obstruction: A case report. Clin Case Rep 2024; 12:e8363. [PMID: 38161623 PMCID: PMC10753128 DOI: 10.1002/ccr3.8363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Abstract
Key Clinical Message Abdominal cocoon syndrome and Chilaiditi syndrome are rare etiologies of bowel obstruction which have to be considered in patients with obstructive symptoms. Patients can profit from surgical management rather than non-surgical approach. Abstract Encapsulating peritoneal sclerosis or abdominal cocoon syndrome (ACS) is an uncommon cause of intestinal obstructions associated with encapsulation of the small bowel by a fibro collagenous sac. Clinical presentations of ACS are unspecific and most patients are diagnosed intraoperatively. Moreover, Chilaiditi syndrome is another rare cause of bowel obstruction defined by interposition of colon and liver. There is no reported relation between these two conditions and surgical intervention is the suggested approach for severe bowel obstruction following them individually. We present a case with both conditions and describe our approach. A 47-year-old male presented with complaints of colic abdominal pain and distention, nausea and several attacks of bilious and nonbilious vomiting, anorexia, and constipation in the last 10 days before his admission. Laboratory data were normal and abdominal X-ray showed large dilation at the distal part of the bowel without air fluid level. The patient underwent explorative laparotomy and a mass-like lesion containing necrotic bowel and a whitish spleen accompanied by a complete anterior-rotated liver was found. The encapsulated bowel and the spleen were resected followed by the complete resolution of symptoms in the patient. The intestinal obstruction caused by ACS is mostly approached by surgery to prevent the fatal sequela of this condition.
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Affiliation(s)
- Ali Tajaddini
- Department of SurgeryShiraz University of Medical SciencesShirazIran
| | | | - Hoda Haghshenas
- Student Research CommitteeJahrom University of Medical SciencesJahromIran
| | | | - Leila Ghahramani
- Colorectal Research CenterShiraz University of Medical SciencesShirazIran
| | - Reza Shahriarirad
- School of MedicineShiraz University of Medical SciencesShirazIran
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical SciencesShirazIran
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5
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Nabata K, Watanabe A, Stuart H. Sclerosing encapsulating peritonitis causing fatal bowel obstruction. BMJ Case Rep 2023; 16:e255625. [PMID: 37923337 PMCID: PMC10626900 DOI: 10.1136/bcr-2023-255625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare condition characterised by a fibrotic peritoneal membrane encasing loops of bowel often resulting in obstruction. We present a case of SEP complicated by non-resolving small bowel obstruction in the context of prior malignancies and surgical complications. A literature review on SEP was performed to outline potential aetiologies, diagnostic investigations and treatment strategies that may be considered in the management of this disease.
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Affiliation(s)
- Kylie Nabata
- General Surgery, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Akie Watanabe
- General Surgery, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Heather Stuart
- General Surgery, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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Jarrad B, Ayasa LA, Abboushi MB, Judeh KA, Almasry N, Hamayel KA, Khader A. Intestinal Obstruction Unraveled: A Rare Case of Primary Sclerosing Encapsulating Peritonitis. Cureus 2023; 15:e42289. [PMID: 37609084 PMCID: PMC10441163 DOI: 10.7759/cureus.42289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2023] [Indexed: 08/24/2023] Open
Abstract
Primary sclerosing encapsulating peritonitis (PSEP), also known as abdominal cocoon syndrome, is a rare condition characterized by small bowel encapsulation by a fibrous membrane or a cocoon-like sac. It is an uncommon cause of intestinal obstruction, as less than 300 cases have been reported from all over the world. We present the case of a 57-year-old male patient who presented with acute abdominal pain, nausea, vomiting, and constipation. A trial of conservative management failed, which warranted surgical intervention. Adhesiolysis was done, resulting in the relief of the intestinal obstruction caused by cocoon syndrome. The patient experienced excellent clinical improvement postoperatively and remained symptom-free during follow-up. Primary sclerosing encapsulating peritonitis poses a diagnostic challenge due to its rarity and nonspecific clinical presentation. A high index of suspicion, a thorough history review, a physical examination, and imaging studies are crucial for an accurate diagnosis. This case report emphasizes the importance of recognizing abdominal cocoon syndrome as a potential cause of intestinal obstruction and highlights the successful management of the condition. This is the first case of such a disease entity to be reported from Palestine.
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Affiliation(s)
- Bashar Jarrad
- General Surgery, Palestine Medical Complex, Ramallah, PSE
| | - Laith A Ayasa
- Internal Medicine, Al-Quds University, Jerusalem, PSE
| | - Mohammed B Abboushi
- Internal Medicine, An Najah National University Faculty of Medicine, Nablus, PSE
| | - Khaled A Judeh
- General Surgery, Palestine Medical Complex, Ramallah, PSE
| | - Nadeem Almasry
- General Surgery, Palestine Medical Complex, Ramallah, PSE
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7
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Chaudhary VK, Vindal A, Kallepalli VSD, Deep V, Vats M, Chellani G, Ansari MN. Primary Sclerosing Encapsulating Peritonitis (PSEP) With Meckel's Diverticulum: A Rare Case Report. Cureus 2023; 15:e39756. [PMID: 37398790 PMCID: PMC10311126 DOI: 10.7759/cureus.39756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare disease. Preoperative diagnosis of SEP can be made with imaging, such as computed tomography (CT). SEP is characterized by a partial or complete encasement of the small intestine by a layer of a thick grayish-white fibro collagenous membrane similar to an abdominal cocoon. The most common symptoms of SEP are abdominal pain, nausea, and vomiting. This rare disease often leads to acute or sub-acute intestinal obstruction. We discuss, in this report, how we managed a case of primary sclerosing encapsulating peritonitis with Meckel's diverticulum at our institution.
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Affiliation(s)
| | - Anubhav Vindal
- Department of Surgery, Maulana Azad Medical College, New Delhi, IND
| | | | - Vivek Deep
- Department of Surgery, Maulana Azad Medical College, New Delhi, IND
| | - Manu Vats
- Department of Surgery, Maulana Azad Medical College, New Delhi, IND
| | - Gautam Chellani
- Department of Surgery, Maulana Azad Medical College, New Delhi, IND
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8
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Alsadery HA, Busbait S, AlBlowi A, Alsawidan M, AlBisher HM, Alshammary S. Abdominal cocoon syndrome (idiopathic sclerosing encapsulating peritonitis): An extremely rare cause of small bowel obstruction-Two case reports and a review of literature. Front Med (Lausanne) 2022; 9:1003775. [PMID: 36314018 PMCID: PMC9596802 DOI: 10.3389/fmed.2022.1003775] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction in which the bowel and internal abdominal organs are wrapped with a fibrocollagenous cocoon-like encapsulating membrane [1,2]. SEP is divided into two entities: abdominal cocoons (AC), also known as idiopathic or primary sclerosing encapsulating peritonitis, which is of extremely rare type, and secondary sclerosing encapsulating peritonitis, which is the more common type. Case presentation Two male patients from India, a 26 year old and a 36 year old, presented to our hospital complaining about abdominal pain associated with nausea and vomiting without any history of previous surgical interventions; the patients' vitals were stable. Preoperative diagnosis of abdominal cocoon was established by abdominal computed tomography. It showed multiple dilated fluid-filled small bowel loops in the center of the abdominal cavity with thin soft tissue, non-enhancing capsules encasing the small bowel loops with mesenteric congestion involving small and large bowel loops. Both patients underwent complete surgical excision of the sac without intraoperative complications. Patients had a smooth postoperative hospital course and were discharged home in good conditions. Conclusion Patients with abdominal cocoons have a non-specific clinical presentation of intestinal obstruction. A high index of clinical suspicion in combination with the appropriate radiological investigation will increase the chance of preoperative detection of the abdominal cocoon. In patients with complete bowel obstruction, complete excision of the peritoneal sac is the standard of care.
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Chorti A, Panidis S, Konstantinidis D, Cheva A, Papavramidis T, Michalopoulos A, Paramythiotis D. Abdominal cocoon syndrome: Rare cause of intestinal obstruction-Case report and systematic review of literature. Medicine (Baltimore) 2022; 101:e29837. [PMID: 35801789 PMCID: PMC9259168 DOI: 10.1097/md.0000000000029837] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Abdominal cocoon or sclerosing encapsulating peritonitis is an uncommon condition in which the small bowel is completely or partially encased by a thick fibrotic membrane. Our study presents a case of sclerosing encapsulating peritonitis and conducts a literature review. METHODS A bibliographic research was conducted. Our research comprised 97 articles. Gender, age, symptoms, diagnostic procedures, and treatment were all included in the database of patient characteristics. CASE PRESENTATION A 51-year-old man complaining of a 2-day history of minor diffuse abdominal pain, loss of appetite, and constipation was presented in emergency department. Physical examination was indicative of intestinal obstruction. Laboratory tests were normal. Diffuse intraperitoneal fluid and dilated small intestinal loops were discovered on computed tomography (CT). An exploratory laparotomy was recommended, in which the sac membrane was removed and adhesiolysis was performed. He was discharged on the tenth postoperative day. RESULTS There were 240 cases of abdominal cocoon syndrome in total. In terms of gender, 151 of 240 (62.9%) were male and 89 of 240 (37%) were female. Ages between 20 and 40 are most affected. Symptoms include abdominal pain and obstruction signs. For the diagnosis of abdominal cocoon syndrome, CT may be the gold standard imaging method. The surgical operation was the treatment of choice in the vast majority of cases (96.7%). Only 69 of 239 patients (28.9%) were detected prior to surgery, and CT was applied in these cases. CONCLUSION Abdominal cocoon is a rare condition marked by recurrent episodes of intestinal obstruction. Surgical therapy is the most effective treatment option.
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Affiliation(s)
- Angeliki Chorti
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- *Correspondence: Angeliki Chorti, 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, St Kiriakidi 1, 54621 Thessaloniki, Greece (e-mail: )
| | - Stavros Panidis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Konstantinidis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angeliki Cheva
- Department of Pathology, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodossis Papavramidis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Michalopoulos
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Daniel Paramythiotis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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10
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Jiao J, Shan K, Xiao K, Liu Z, Zhang R, Dong K, Liu J, Teng Q, Shang L, Li L. Case Report: Abdominal Cocoon With Jejuno-Ileo-Colonic Fistula. Front Surg 2022; 9:856583. [PMID: 35574535 PMCID: PMC9095931 DOI: 10.3389/fsurg.2022.856583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Abdominal cocoon is a unique peritoneal disease that is frequently misdiagnosed. The occurrence of the abdominal cocoon with a jejuno-ileo-colonic fistula has not been previously reported. Case Presentation We admitted a 41-year-old female patient with an abdominal cocoon and a jejuno-ileo-colonic fistula. She was admitted to our hospital for the following reasons: “the menstrual cycle is prolonged for half a year, and fatigue, palpitations, and shortness of breath for 2 months”. On the morning of the 4th day of admission, the patient experienced sudden, severe, and intolerable abdominal pain after defecating. An emergency abdominal CT examination revealed intestinal obstruction. Surgery was performed, and the small intestine and colon were observed to be conglutinated and twisted into a mass surrounded by a fibrous membrane, and an enteroenteric fistula was observed between the jejunum, ileum, and sigmoid colon. We successfully relieved the intestinal obstruction and performed adhesiolysis. The patient was discharged from our hospital on the 6th postoperative day, then she recovered and was discharged from Feicheng People's Hospital after another 11 days of conservative treatment, and she recovered well-during the 2-month follow-up period. Conclusion Abdominal cocoon coexisting with a jejuno-ileo-colonic fistula is very rare. During the process of abdominal cocoon treatment, the patient's medical history should be understood in detail before the operation, and the abdominal organs should be carefully evaluated during the operation to avoid missed diagnoses.
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Affiliation(s)
- Jian Jiao
- Shandong First Medical University, Jinan, China
| | - Keshu Shan
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Kun Xiao
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhenjun Liu
- Department of Gastrointestinal Surgery, Feicheng Hospital Affiliated to Shandong First Medical University, FeiCheng People's Hospital, Feicheng, China
| | - Ronghua Zhang
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Kangdi Dong
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jin Liu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Qiong Teng
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liang Shang
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Liang Shang
| | - Leping Li
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Leping Li
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11
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Brückner M, Bogisch S. Laparoscopic ovariectomy in a dog with type III sclerosing encapsulating peritonitis and literature review. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2022; 50:138-143. [PMID: 35523167 DOI: 10.1055/a-1811-4052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sclerosing encapsulating peritonitis is a rare and not well-recognized disease in veterinary medicine. A 14-month-old female intact mixed-breed dog was diagnosed with sclerosing encapsulating peritonitis (SEP) at the age of 5 months after a routine work-up including biopsies from an exploratory laparotomy. Symptomatic treatment with an immunosuppressive dose of prednisolone was started, but dose reduction was unsuccessful. Combined treatment with tamoxifen, a selective estrogen receptor modulator used for its TGF-β1 suppression of fibroblasts was discussed; the owner was informed about the risk for developing a pyometra. About one year later the owner wanted to spay her dog and an ovariectomy was recommended, especially due to the extensive adhesions. A laparoscopic approach was chosen to reduce the amount of intraoperative tissue manipulation and inflammation, as well as to minimize the size of the incision. The dog continues to be doing well one year after surgery and prednisolone could be reduced to a low maintenance dose after surgery; so far, the addition of tamoxifen was not required. In selected cases, laparoscopy appears as a safe alternative in patients with adhesions, but the surgeon should always be prepared to convert in case of impaired vision, especially in the absence of tactile sensation. This case report is the first description of laparoscopy in a dog with SEP. Laparoscopy may serve as an easily accomplished minimally invasive method to diagnose SEP, but further studies are required.
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12
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Hu Q, Shi J, Sun Y. Abdominal Cocoon With Intestinal Perforation: A Case Report. Front Surg 2021; 8:747151. [PMID: 34722624 PMCID: PMC8554061 DOI: 10.3389/fsurg.2021.747151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Abdominal cocoon is a very rare abdominal disease. Abdominal cocoon mainly leads to intestinal obstruction, and abdominal cocoon with gastrointestinal perforation is rare. Case Presentation: We report a 63-year-old man who was admitted to our hospital with “persistent lower abdominal pain for one day”. Abdominal CT examination revealed a small amount of free gas in the abdominal cavity, ascites, and gastrointestinal perforation. An emergency operation was performed. During the operation, the end of the right lower abdominal ileum was found to be conglutinated and twisted into a mass, a local intestinal dilatation, and obstruction, local intestinal wall was black and gangrene, and fecal effusion flowed out. The adhesions were carefully separated, and the necrotic small intestine was removed. The operation process went smoothly, and the patient recovered well after the operation. Conclusion: The cases of intestinal perforation caused by the abdominal cocoon are very rare. In clinical work, when we encounter patients with gastrointestinal perforation, we need to carefully ask the history. When the patients had no digestive system diseases in the past, we need to consider the possibility of the abdominal cocoon with perforation.
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Affiliation(s)
- Qiang Hu
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Jianfeng Shi
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Yuanshui Sun
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
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13
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Aziz W, Malik Y, Haseeb S, Mirza RT, Aamer S. Abdominal Cocoon Syndrome: A Laparoscopic Approach. Cureus 2021; 13:e16787. [PMID: 34513394 PMCID: PMC8405409 DOI: 10.7759/cureus.16787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 01/01/2023] Open
Abstract
Sclerosing encapsulating peritonitis, or abdominal cocoon syndrome (ACS), is a rare cause of intestinal obstruction in which the small bowel is encapsulated by a fibro-collagenous membrane. We present the case of a 29-year-old male who presented to us with acute intestinal obstruction. The imaging performed suggested the presence of ACS. The patient underwent laparoscopic adhesiolysis and the small bowel was released. In cases of recurrent small bowel obstruction, a high index of suspicion is required for the diagnosis of ACS. Computed tomography can be a useful imaging modality, and surgery remains the mainstay of treatment.
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Affiliation(s)
- Waqas Aziz
- General Surgery, Shifa International Hospital Islamabad, Islamabad, PAK
| | - Yashfeen Malik
- General Surgery, Shifa International Hospital Islamabad, Islamabad, PAK
| | - Shahan Haseeb
- Internal Medicine, Shifa International Hospital Islamabad, Islamabad, PAK
| | - Rida T Mirza
- General Surgery, Shifa International Hospital Islamabad, Islamabad, PAK
| | - Sameen Aamer
- Internal Medicine, Shifa International Hospital Islamabad, Islamabad, PAK
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14
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Bhatta OP, Verma R, Shrestha G, Sharma D, Dahal R, Kansakar PBS. An unusual case of intestinal obstruction due to abdominal cocoon: A case report. Int J Surg Case Rep 2021; 85:106282. [PMID: 34388909 PMCID: PMC8358643 DOI: 10.1016/j.ijscr.2021.106282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Abdominal cocoon (AC) or Encapsulating Peritoneal Sclerosis (EPS) is a rare cause of bowel obstruction and due to non-specific presentation, it can be misdiagnosed and often mistreated. CASE PRESENTATION We present the case of 42 years male with a history suggestive of complete small bowel obstruction (SBO) without a history of pulmonary tuberculosis (TB) or peritoneal dialysis. CT imaging as well as the intraoperative finding of a cocoon membrane encasing the small bowel led to the diagnosis of abdominal cocoon. CLINICAL DISCUSSION Abdominal cocoon can be idiopathic or secondary to peritoneal dialysis, tuberculosis, or other rare causes. Patients usually present with features of SBO with varying severity. Diagnosis is aided by imaging investigations mainly CT scan and management is primarily surgical and usually involves adhesiolysis, total removal of the membrane with or without bowel loop resection. CONCLUSION Diagnosis of abdominal cocoon warrants awareness of the disease and a high index of suspicion of the treating clinician in patients with intestinal obstruction and an abdominal lump without a history of previous abdominal surgery. CT can guide diagnosis and early operative management seems to bear the best outcomes.
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Affiliation(s)
- Om Prakash Bhatta
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.
| | - Rupesh Verma
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Gyaneswor Shrestha
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Deepak Sharma
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Romi Dahal
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Prasan Bir Singh Kansakar
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
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15
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Ni Z, Chen Q, Huang C, Wang S, Huang Q. Sclerosing encapsulating peritonitis as a rare cause of intestinal obstruction after the treatment of peritoneal mesothelioma: a case report and review of the literature. Transl Cancer Res 2021; 10:3074-3080. [PMID: 35116616 PMCID: PMC8798027 DOI: 10.21037/tcr-20-3259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 03/12/2021] [Indexed: 11/09/2022]
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction that is characterized by a thick greyish-white fibrotic membrane encasing the small bowel. The clinical features are typically nonspecific, and they occasionally present with recurrent episodes of incomplete or complete intestinal obstruction. The etiology of SEP remains unclear, and the diagnosis is often delayed mainly due to the lack of specific symptoms. Here, we first report a patient who suffered from SEP after treatment for malignant mesothelioma (MM) with tumor resection supplemented with hyperthermic intraperitoneal chemotherapy (HIPEC) once and intraperitoneal chemotherapy (IPC) eight times. The patient was discharged ten days after surgery and was free of complications at the 4-month follow-up. In addition, we reviewed the published literature from PubMed, only 7 articles of 16 cases finally met the defined requirements. Nine cases of SEP after IPC and 7 cases of SEP after HIPEC were previously reported. We synthetically review the pathogenesis, treatments, and outcomes. In conclusion, SEP is a rare abdominal disease, which is difficult to diagnose preoperatively. CT scanning is the most helpful imaging method for the diagnosis of SEP. Surgery is the most effective method for diagnosis and treatment, if conservative treatment has no effect or abdominal symptoms are aggravated.
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Affiliation(s)
- Zhizhan Ni
- Department of General Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qing Chen
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chenshen Huang
- Department of General Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Song Wang
- Department of General Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qi Huang
- Department of General Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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16
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Mathew KG, Akhtar S, Pius SI. Abdominal cocoon: precipitated by laparoscopic gas insufflation. BMJ Case Rep 2021; 14:e240024. [PMID: 33811094 PMCID: PMC8023630 DOI: 10.1136/bcr-2020-240024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2021] [Indexed: 11/04/2022] Open
Abstract
A young male in his early 30s presented to us with increasing swelling at the umbilicus, and an umbilical hernia was diagnosed. At laparoscopic intraperitoneal onlay mesh (IPOM) repair, an unexpected finding of a thin innocuous-looking fibrous film over the small bowel was noted. This finding presented a dilemma as to the probable pathology of this material, and a decision had to be made on whether laparoscopic IPOM could be continued. It was prudently decided to abandon the plan of placing a mesh intraperitoneally and an open repair of the umbilical hernia was done. In retrospect this was a wise decision, as, after 7 months he had to have a laparotomy for intestinal obstruction, when the classic thick fibrous encapsulating abdominal cocoon was seen. Hence here we have followed the evolution of the abdominal cocoon from its original asymptomatic phase to the classic encapsulating sclerosing peritonitis with probably laparoscopic gas insufflation being the precipitating factor.
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17
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Encapsulating peritoneal sclerosis caused by cell-free and concentrated ascites reinfusion therapy: a case report. J Med Case Rep 2021; 15:35. [PMID: 33546732 PMCID: PMC7866455 DOI: 10.1186/s13256-021-02679-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background Encapsulating peritoneal sclerosis (EPS) is a rare condition in which the small intestine is covered by an inflammatory fibrocollagenous membrane; the exact etiology of EPS is unclear. Herein, we report the case of our patient who underwent hemodialysis and cell-free and concentrated ascites reinfusion therapy (CART) and was diagnosed with EPS. Case presentation A 64-year-old Japanese man visited our emergency department with a chief complaint of abdominal pain. He had a medical history of cirrhosis due to hepatitis C for 25 years. He had undergone partial resection of the small intestine 2 years earlier for an incarcerated hernia. One year earlier, he experienced renal failure due to hepatorenal syndrome and started hemodialysis three times a week and CART twice a month. Physical examination of the abdominal wall revealed a lack of peristalsis of the intestinal tract and strong tenderness on palpation. Because hernia of the small intestine was found on computed tomography, we suspected strangulation ileus, requiring emergency operation. When the abdomen was opened, the entire small intestine was found to be wrapped in a fibrous membrane and constricted by it. The patient was diagnosed with EPS; hence, during surgery, the fibrous membrane was excised, resulting in decompression of the intestinal tract and subsequent recovery. Conclusions EPS is thought to be related to various elements, but no case of EPS induced by CART has been reported to date. EPS should be considered in the differential diagnosis of small bowel obstruction in patients undergoing CART for refractory ascites.
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18
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Kang JH. A rare case of intestinal obstruction: Sclerosing encapsulating peritonitis of unknown cause. Turk J Emerg Med 2020; 20:152-155. [PMID: 32832736 PMCID: PMC7416848 DOI: 10.4103/2452-2473.290068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/23/2020] [Indexed: 12/15/2022] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is characterized by the partial or complete enclosing of the small intestines by a thick fibro-collagenous membrane, which can cause recurrent intestinal obstruction. SEP is a clinically rare disease, and the major risk factor is peritoneal dialysis (PD). Early diagnosis of SEP is an important factor in the patient's prognosis, but it is clinically difficult. A 52-year-old woman visited the emergency department (ED) with a 2-day history of abdominal pain and vomiting. She had a history of liver cirrhosis with chronic hepatitis B, but no history of PD, and she underwent a biopsy of the peritoneum by laparoscopy a month ago. On physical examination, there were peritoneal irritation signs on the right lower quadrant (RLQ). Abdominal computed tomography (CT) showed dilated small intestinal loops clustered in the RLQ, which were surrounded by a sac-like, thick fibrous membrane. Based on CT findings, small intestinal obstruction due to SEP was early diagnosed in the ED. Emergency physicians should include SEP in the differential diagnosis of the cause of intestinal obstruction. Abdominal CT is a useful modality for the early diagnosis of SEP in the ED.
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Affiliation(s)
- Jeong Ho Kang
- Department of Emergency Medicine, Jeju National University School of Medicine, Jeju-do, Republic of Korea
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19
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Zhou H, Xu J, Xie X, Han J. Idiopathic cocoon abdomen with congenital colon malrotation: a case report and review of the literature. BMC Surg 2020; 20:124. [PMID: 32517682 PMCID: PMC7282167 DOI: 10.1186/s12893-020-00788-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 06/01/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Cocoon abdomen is a relatively rare abdominal disease characterized by the total or partial encasement of the small intestinal by a dense fibro-collagenous membrane. CASE PRESENTATION We reported an unusual case of idiopathic cocoon abdomen with congenital colon malrotation. Laparotomy and sac release were performed on the patient. The patient was no recurrence 6 months after operation. A literature review was also performed. CONCLUSION Preoperative diagnosis of abdominal cocoon is difficult. A careful history, physical examination and appropriate radiology may be helpful in making a definitive diagnosis. If conservative treatment can't relieve symptoms effectively, surgery is currently considered to be important in the management of this disease.
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Affiliation(s)
- Hui Zhou
- Department of General Surgery, Wuhan Third Hospital, Wuhan, 430060, People's Republic of China.
| | - Jinling Xu
- Department of Endocrinology and Metabolism, The General Hospital of Central Theater Command, Wuhan, 430070, People's Republic of China
| | - Xingwang Xie
- Department of General Surgery, Wuhan Third Hospital, Wuhan, 430060, People's Republic of China
| | - Jiantao Han
- Department of General Surgery, Wuhan Third Hospital, Wuhan, 430060, People's Republic of China
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20
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Isaac I, Carrera I, Martí J, DiBella A. Resolution of sclerosing encapsulating peritonitis in a young dog. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2019-001022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Ingrid Isaac
- Southern Counties Veterinary SpecialistsRingwoodUK
| | - Ines Carrera
- Department of Diganostic ImagingSouthern Counties Veterinary SpecialistsRingwoodHampshireUK
| | - Juan Martí
- Department of SurgerySoft Tissue SurgerySouthern Counties Veterinary SpecialistsRingwoodHampshireUK
| | - Andrea DiBella
- Department of Internal MedicineSouthern Counties Veterinary SpecialistsRingwoodHampshireUK
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21
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Two Different Clinical Approaches with Mortality Assessment of Four Cases: Complete and Incomplete Type of Abdominal Cocoon Syndrome. Case Rep Surg 2020; 2020:4631710. [PMID: 32082687 PMCID: PMC7008279 DOI: 10.1155/2020/4631710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/20/2020] [Indexed: 01/01/2023] Open
Abstract
Abdominal cocoon syndrome (ACS), also called sclerosing encapsulated peritonitis, is a condition characterized by encapsulation of all or some of small bowel loops by a thick fibrous membrane. Etiologic cause is not fully known. It is among the rare causes of intestinal obstruction in adults. Preoperative diagnosis is difficult, and high suspicion is required. Diagnosis is generally made during laparotomy performed due to mechanical obstruction. In treatment of the condition, large scale surgical resections should be avoided. In the present study, we aimed to evaluate all clinical and radiological characteristics and surgical treatment of ACS in light of the literature through four patients operated in our clinic.
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22
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Gaszynski R, Gray A, Apostolou C, Merrett N. Laparoscopic diagnosis and management of peritonitis chronica fibrosa incapsulata. ANZ J Surg 2020; 90:1795-1796. [PMID: 31919966 DOI: 10.1111/ans.15673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/19/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Rafael Gaszynski
- Department of Upper Gastrointestinal Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Andrew Gray
- Department of Upper Gastrointestinal Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Christos Apostolou
- Department of Upper Gastrointestinal Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Neil Merrett
- Department of Upper Gastrointestinal Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
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23
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Park GH, Lee BC, Hyun DW, Choi JB, Park YM, Jung HJ, Jo HJ. Mechanical intestinal obstruction following laparoscopic inguinal hernia repair in a patient with abdominal cocoon syndrome. J Surg Case Rep 2019; 2019:rjz370. [PMID: 31867099 PMCID: PMC6917468 DOI: 10.1093/jscr/rjz370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/26/2019] [Indexed: 12/11/2022] Open
Abstract
Abdominal cocoon syndrome (ACS) is a rare condition characterized by partial or complete encasement of small intestine by a thick fibro-collagenous membrane. A 65-year-old man presented to the surgical department with left inguinal. He underwent laparoscopic transabdominal preperitoneal inguinal hernia. When we inserted a trocar into the peritoneal cavity, the small intestine was injured and repaired immediately. We identified a fibrotic membrane covering the small intestine, which was found as ACS. Two weeks later after discharge, he presented to the emergency department with mechanical intestinal obstruction. Conservative treatment had no effect on the patient and membrane excision, adhesiolysis and small intestine resection with anastomosis were performed. Unfortunately, the patient was hospitalized for a long time with bowel leakage and discharged on postoperative day 48. The preoperative diagnosis is quite challenging and most cases are diagnosed intraoperatively. When finding the ACS during the operation, careful attention should be needed.
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Affiliation(s)
- Geon Hi Park
- Department of Surgery, Pusan National University Hospital, Busan 49241, Korea
| | - Byoung Chul Lee
- Department of Surgery, Pusan National University Hospital, Busan 49241, Korea
| | - Dong Woo Hyun
- Department of Surgery, Pusan National University Hospital, Busan 49241, Korea
| | - Jung Bum Choi
- Department of Surgery, Pusan National University Hospital, Busan 49241, Korea
| | - Young Mok Park
- Department of Surgery, Pusan National University Hospital, Busan 49241, Korea
| | - Hyuk Jae Jung
- Department of Surgery, Pusan National University Hospital, Busan 49241, Korea
| | - Hong Jae Jo
- Department of Surgery, Pusan National University Hospital, Busan 49241, Korea
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24
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Singh H, Irrinki S, Yadav TD, Kumar H, Kharel J, Dhaka N, Mandavdhare H, Sharma V. Surgical Outcomes in Patients with Abdominal Cocoon: Series of 15 Patients. World J Surg 2019; 43:2143-2148. [PMID: 31011822 DOI: 10.1007/s00268-019-05006-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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25
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Garg N, Sindwani G, Arora MK, Pamecha V. Living donor liver transplantation in a patient with cocoon abdomen - Anesthesia concerns! Saudi J Anaesth 2019; 13:75-77. [PMID: 30692895 PMCID: PMC6329246 DOI: 10.4103/sja.sja_655_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cocoon abdomen is a rare condition in which abdominal structures are surrounded by thick encapsulating peritoneum resulting in dense adhesions. Liver transplant is a high risk surgery with an already increased risk of massive blood loss due to the pre-existing coagulopathy and portal hypertension. Presence of cocoon abdomen with severe dense adhesions can either lead to difficult hepatectomy with massive intra-operative blood loss or failure to proceed with the surgery. This becomes even more important in live donor liver transplantation where it may not be possible to abandon the surgery once the donor liver resection is started. Thus keeping a high suspicion of cocoon abdomen in patients with previous history of kochs abdomen and on long term beta blocker therapy is of utmost importance and this can decrease the morbidity and mortality associated with this condition. A 41 year old male known case of chronic liver disease was posted for live donor liver transplantation. After opening the abdomen thick dense adhesions were found around the intestines and the liver. Due to the dense adhesions surgical team was in dilemma whether to proceed further for the surgery or not. Intra-operatively patient had a blood loss of 12.5 litre. Despite massive transfusion the postoperative course went uneventful and the patient was extubated on 2nd post-operative day. He was shifted out of Intensive care unit on the 6th post-operative day. Cocoon abdomen should be suspected in a chronic liver disease patient with previous history of tuberculosis or on long term beta blocker therapy. Proper preparation before surgery can decrease the morbidity and mortality associated with this major surgery. Our case report clearly shows that such types of patients can be taken up for the live donor liver transplantation surgery with a precaution to start donor hepatectomy only after surgeon has assessed the difficulty status of recipient hepatectomy.
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Affiliation(s)
- Neha Garg
- Department of Anesthesia, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Gaurav Sindwani
- Department of Anesthesia, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Mahesh Kumar Arora
- Department of Anesthesia, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vinyendra Pamecha
- Department of HPB and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India
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26
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Beckman RM, Stevens KA, Jones C. Chronic Bowel Obstruction in a Middle-aged Man. JAMA Surg 2019; 154:83-84. [PMID: 30140932 DOI: 10.1001/jamasurg.2018.2582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ross M Beckman
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kent A Stevens
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christian Jones
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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27
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Xia J, Xie W, Chen L, Liu D. Abdominal cocoon with early postoperative small bowel obstruction: A case report and review of literature in China. Medicine (Baltimore) 2018; 97:e11102. [PMID: 29924005 PMCID: PMC6023681 DOI: 10.1097/md.0000000000011102] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Abdominal cocoon is a condition in which intestinal obstruction results from the encasement of part or whole of the small bowel by a thick fibrous membrane, giving the appearance of a cocoon. The preoperative diagnosis is difficult to be made and the treatment is still controversial. PATIENT CONCERNS Here we describe the case of a 62-year-old male presented with a 24-h history of continual colicky abdominal pain, which was accompanied with nausea and vomiting. DIAGNOSIS Accurate diagnosis of abdominal cocoon was made intraoperatively. INTERVENTIONS Membrane excision and adhesiolysis were performed and the patient experienced early postoperative small bowel obstruction. Nasointestinal obstruction tube was then installed and bowel function was gradually recovered by the 20th postoperative day. OUTCOMES The patient recovered well and was discharged from the hospital on the 30th postoperative day LESSONS:: Abdominal cocoon can occur at any age. The possibility of abdominal cocoon should also be considered in infertile patients. Imaging studies may be helpful to make the correct diagnosis, and surgery should be performed for patients with recurrent acute or chronic intestinal obstruction.
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28
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Blajin A, Cristian D, Sălcianu I, Welt L, Scăunaşu RV, Berevoescu N, Blajin C, Burcoş T. The diagnostic and therapeutic management of a peculiar case of rectal submucosal adenocarcinoma. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2018. [DOI: 10.25083/2559.5555/31.4752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction. We are presenting the case of a 50 years old female patient with rectal cancer, developed from the submucosal level, who raised difficulties in diagnoses process and therapeutic management. Case report. The patient’s symptomatology began four months before the definitive diagnose. Various investigations have been performed, including multiple biopsies which were inconclusive. Surgical intervention was performed to obtain definitive malignancy HP result. The postoperative evolution was peculiar, marked by complications, which required multiple surgical interventions. Conclusions. The development of the adenoma, predominantly at the submucosal and muscular level has caused difficulties in both establishing the diagnosis and in the therapeutic management. Sclerosing encapsulated peritonitis (SEP) is a rare clinical entity, usually discovered in postoperative intestinal obstruction cases. The etiology and frequency of SEP depend on its’ type.
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29
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Li S, Wang JJ, Hu WX, Zhang MC, Liu XY, Li Y, Cai GF, Liu SL, Yao XQ. Diagnosis and Treatment of 26 Cases of Abdominal Cocoon. World J Surg 2017; 41:1287-1294. [PMID: 28050667 DOI: 10.1007/s00268-016-3855-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Abdominal cocoon (AC) is a rare abdominal disease with nonspecific clinical features, and it is difficult to be diagnosed before operation and hard to be treated in clinical practice. The aim of this study is to investigate the diagnosis and treatment of AC. METHODS The clinical manifestations, findings during surgery, treatments, and follow-up results of 26 cases of AC were retrospectively studied from January 2001 to January 2015. RESULTS All of 26 cases were diagnosed as AC definitely by laparotomy or laparoscopic surgery. Their clinical findings were various, with 7 intestines obstructed with bezoars and 4 intestines perforated by spiny material. Based on the existence of the second enterocoelia, all cases were categorized into 2 types: type I is absent of second enterocoelia (18 cases, 69.23%), while type II shows second enterocoelia (8 cases, 30.77%). Twenty cases (12 were type I and 8 were type II) underwent membrane excision and careful enterodialysis to release the small intestine entirely or partially, while the other 6 cases (all were type I) did not. In addition, all patients were treated with medical treatment and healthy diet and lifestyle. Finally, most of the patients recovered smoothly. CONCLUSIONS AC can be categorized into two types; surgery is recommended for type II and part of type I with severe complications, but sometimes conservative therapy might be appropriate for type I. Laparoscopic surgery plays an important role in the diagnosis and treatment of AC. Furthermore, favorite health education, healthy diet and lifestyle are of significance in patients' recovery.
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Affiliation(s)
- Sheng Li
- Southern Medical University, Guangzhou, China.,Department of Gastrointestinal Surgery, Central Hospital of Shaoyang, Shaoyang, Hunan, China.,Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jun-Jiang Wang
- Southern Medical University, Guangzhou, China.,Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei-Xian Hu
- Southern Medical University, Guangzhou, China.,Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mou-Cheng Zhang
- Southern Medical University, Guangzhou, China.,Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Gastrointestinal Surgery, First Hospital of Ningbo, Ningbo, Zhejiang, China
| | - Xian-Yan Liu
- Department of Gastrointestinal Surgery, Central Hospital of Shaoyang, Shaoyang, Hunan, China
| | - Yong Li
- Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guan-Fu Cai
- Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Sen-Lin Liu
- Department of Gastrointestinal Surgery, Central Hospital of Shaoyang, Shaoyang, Hunan, China
| | - Xue-Qing Yao
- Southern Medical University, Guangzhou, China. .,Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China.
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30
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SINGAL RIKKI, SATYASHREE B, MITTAL AMIT, SHARMA BHANUPRATAP, SINGAL SAMITA, ZAMAN MUZZAFARR, SHARDHA PARTEEK. Tubercular abdominal cocoon in children - a single centre study in remote area of northern India. CLUJUL MEDICAL (1957) 2017; 90:179-184. [PMID: 28559702 PMCID: PMC5433570 DOI: 10.15386/cjmed-725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/02/2016] [Accepted: 11/08/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Amongst the numerous causes of intestinal obstruction listed in the literature, sclerosing encapsulating peritonitis also called Abdominal Cocoon (AC) is one of the rarest entities. Its characteristic feature is a thick fibrotic membrane encasing varying lengths of the small and large gut in a cocoon. In India, there is an increasing incidence of tuberculosis, especially in the rural areas. AIMS AND OBJECTIVES The aim of this study was to investigate the clinical presentation and evaluate the operative findings of tuberculous AC. We also evaluated the outcomes and response to anti tuberculous treatment (ATT) in all the patients diagnosed with this condition. MATERIAL AND METHODS This study was carried out at M.M. Institute of Medical Sciences and Research, Mullana, Ambala, India between April 2013 - March 2016 in the Department of Pediatric Surgery. This is a prospective study. A total of 17 patients diagnosed with abdominal cocoon secondary to tuberculosis have been included in the study. RESULTS A total of 17 patients presented to the emergency ward with features of acute intestinal obstruction. The average age was 15.3 years (range 9 years to 16 years). There were 14 females and 3 males. All patients presented with abdominal pain, bilious vomiting, constipation and abdominal distention. The patients were operated in our hospital and relieved of their obstruction. Based on their operative findings and after histopathological confirmation, patients were given ATT. In the follow-up, all patients did well, without recurrence of tuberculosis or intestinal obstruction. CONCLUSION Tuberculosis as a cause of childhood AC is rather common in developing countries and is potentially a fatal condition. A strong clinical suspicion, sonographic and computed tomography scan findings help establish a pre-operative diagnosis. Tuberculous AC has a strong prevalence in females. Surgery is the mainstay of treatment followed by anti-tuberculous drugs.
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Affiliation(s)
- RIKKI SINGAL
- Department of Surgery - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
- Address for correspondence:
| | - B SATYASHREE
- Department of Pediatric Surgery - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
| | - AMIT MITTAL
- Department of Radiodiagnosis and Imaging - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
| | - BHANU PRATAP SHARMA
- Department of Surgery - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
| | - SAMITA SINGAL
- Department of Radiodiagnosis and Imaging - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
| | - MUZZAFARR ZAMAN
- Department of Surgery - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
| | - PARTEEK SHARDHA
- Department of Surgery - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
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Allam H, Al Yahri O, Mathew S, Darweesh A, Suliman AN, Abdelaziem S, Khairat M, Toro A, Di Carlo I. The enigma of primary and secondary encapsulating peritoneal sclerosis. BMC Surg 2016; 16:81. [PMID: 27964725 PMCID: PMC5153754 DOI: 10.1186/s12893-016-0198-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/30/2016] [Indexed: 12/21/2022] Open
Abstract
Background Encapsulating Peritoneal Sclerosis (EPS) describes a variety of diseases that are frequently confused with different names and different etiopathogeneses. The aim of this article is to report personal experience of focusing on correct classification and the status of current diagnosis and treatment. Methods A retrospective analysis was performed. Age, sex, ethnic origin, past medical history, symptoms and their duration, radiological tools and signs, laboratory tests, preoperative diagnosis, surgical approach, intraoperative findings, pathological findings, hospital stay, morbidity and mortality were studied. Results A total of seven patients, including six males and one female, aged from 24 to 72 years were observed. Four patients had recurrent abdominal colic pain for 3 months, 1, 2 and 9 years; two patients also reported recurrent attacks but without any specification of the duration. All seven patients presented at the emergency department with abdominal pain that was mainly diffused over the entire abdomen. Six patients were submitted to a CT scan. Only in two patients was the diagnosis of EPS made preoperatively. All seven patients were submitted to open surgery. The hospital stay was between 4 and 60 days. One patient had morbidity, and one patient died of MOF. Conclusions Currently, the correct identification of EPS is more easily possible than in the past, but the diagnosis is still a challenge. Surgery must be performed as soon as possible to avoid a poorer quality of life.
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Affiliation(s)
- Hisham Allam
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050, Doha, Qatar
| | - Omer Al Yahri
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050, Doha, Qatar
| | - Sharon Mathew
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050, Doha, Qatar
| | - Adham Darweesh
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Ahmed Nafea Suliman
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050, Doha, Qatar
| | - Sherif Abdelaziem
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050, Doha, Qatar
| | - Mohamed Khairat
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050, Doha, Qatar
| | - Adriana Toro
- Department of General Surgery, Barone I. Romeo Hospital, Patti, Messina, Italy
| | - Isidoro Di Carlo
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050, Doha, Qatar. .,Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy.
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Machado NO. Sclerosing Encapsulating Peritonitis: Review. Sultan Qaboos Univ Med J 2016; 16:e142-51. [PMID: 27226904 DOI: 10.18295/squmj.2016.16.02.003] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/11/2016] [Accepted: 02/25/2016] [Indexed: 12/12/2022] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare chronic inflammatory condition of the peritoneum with an unknown aetiology. Also known as abdominal cocoon, the condition occurs when loops of the bowel are encased within the peritoneal cavity by a membrane, leading to intestinal obstruction. Due to its rarity and non-specific clinical features, it is often misdiagnosed. The condition presents with recurrent episodes of small bowel obstruction and can be idiopathic or secondary; the latter is associated with predisposing factors such as peritoneal dialysis or abdominal tuberculosis. In the early stages, patients can be managed conservatively; however, surgical intervention is necessary for those with advanced stage intestinal obstruction. A literature review revealed 118 cases of SEP; the mean age of these patients was 39 years and 68.0% were male. The predominant presentation was abdominal pain (72.0%), distension (44.9%) or a mass (30.5%). Almost all of the patients underwent surgical excision (99.2%) without postoperative complications (88.1%).
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Affiliation(s)
- Norman O Machado
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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Yang CS, Kim D. Unusual intestinal obstruction due to idiopathic sclerosing encapsulating peritonitis: a report of two cases and a review. Ann Surg Treat Res 2016; 90:231-4. [PMID: 27073795 PMCID: PMC4826987 DOI: 10.4174/astr.2016.90.4.231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 01/26/2016] [Accepted: 02/15/2016] [Indexed: 02/08/2023] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction that is characterized by a thick fibrotic membrane encasing the small intestine like a cocoon. Accurate preoperative diagnosis is often difficult. We present 2 cases of SEP that were diagnosed preoperatively by contrast-enhanced computed tomography scan. A 38-year-old man and a 56-year-old woman were admitted to Daegu Catholic University Medical Center because of recurrent intestinal obstruction. We performed exploratory laparotomy with doubt of the preoperative diagnosis of SEP. We confirmed the diagnosis of SEP on laparotomy and performed adhesiolysis. Both patients recovered successfully and had no signs of recurrence. A better awareness of SEP and its radiological features should lead to more correct preoperative diagnosis and result in more appropriate management, including surgery.
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Affiliation(s)
- Chun-Seok Yang
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Daedong Kim
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
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Illán Riquelme A, Camacho Lozano J, Abdalahi H, Calado Leal C, Huertas Riquelme J. Abdominal Cocoon: A rare cause of intestinal obstruction. Cir Esp 2016; 94:417-9. [PMID: 26987966 DOI: 10.1016/j.ciresp.2016.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 01/06/2016] [Accepted: 01/24/2016] [Indexed: 02/07/2023]
Affiliation(s)
| | - Julio Camacho Lozano
- Servicio de Cirugía General, Hospital Marina Baixa, Villajoyosa, Alicante, España
| | - Hama Abdalahi
- Servicio de Cirugía General, Hospital Marina Baixa, Villajoyosa, Alicante, España
| | - Carlos Calado Leal
- Servicio de Cirugía General, Hospital Marina Baixa, Villajoyosa, Alicante, España
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Surgical treatment and perioperative management of idiopathic abdominal cocoon: single-center review of 65 cases. World J Surg 2015; 38:1860-7. [PMID: 24519587 DOI: 10.1007/s00268-014-2458-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The abdominal cocoon (AC) is a condition in which a variable length of healthy small bowel is enveloped in a fibrocollagenous membrane, giving the appearance of a cocoon. Early experiences with treatment were associated with high mortality and morbidity rates and a low preoperative diagnostic rate, leading to underestimation of the treatment benefit of surgery. METHODS We retrospectively reviewed the medical records of 65 patients who were diagnosed as having AC from 2001 to 2011. The clinical data, surgical intervention, and perioperative management were carefully reviewed. RESULTS The 65 patients (57 male, 8 female) had a median age of 39 years (range 14-79 years). Patients who received preoperative nutritional support had higher rate of grade 0 complications (p = 0.012) and a lower rate of grade II complications (p = 0.012) than those without nutritional support. Intestinal stenting during surgical intervention also decreased both grade I (p = 0.012) and grade II (p = 0.007) complications. Patients who received preoperative nutritional support and underwent intestinal stenting had a lower rate of postoperative complications (p < 0.05). In addition, patients with preoperative nutritional support were more satisfied postoperatively (p = 0.018) than those without nutritional support. This was also observed in patients with intestinal stenting versus those without it (p = 0.027). CONCLUSIONS Our single-center study with a large number of patients provided evidence regarding the epidemiology of AC. Preoperative nutritional support and intestinal stenting significantly reduced postoperative complications and, more importantly, increased postoperative satisfaction.
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Zhang Y, Liu WD, He JT, Liu Q, Zhai DG. A rare case of abdominal cocoon presenting as umbilical hernia. Chin Med J (Engl) 2015; 128:1415-7. [PMID: 25963367 PMCID: PMC4830326 DOI: 10.4103/0366-6999.156815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Yu Zhang
- National Hepatobiliary and Enteric Surgery Research Center, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
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Yavuz R, Akbulut S, Babur M, Demircan F. Intestinal Obstruction Due to Idiopathic Sclerosing Encapsulating Peritonitis: A Case Report. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e21934. [PMID: 26082852 PMCID: PMC4464369 DOI: 10.5812/ircmj.17(5)2015.21934] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 03/23/2015] [Accepted: 04/11/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Sclerosing encapsulating peritonitis (SEP) is characterized by partial or complete encasement of small intestine by a thick fibrocollagenous membrane. Depending on underlying causes, SEP is divided into primary and secondary forms. Idiopathic SEP is also called idiopathic or abdominal cocoon syndrome. Herein we presented a case of idiopathic SEP. CASE PRESENTATION A 90-year-old male patient presented to our emergency department with signs and symptoms of intestinal obstruction and dehydration. Physical examination findings, patient's age and plain abdominal radiography were consistent with tumoral obstruction or viscus perforation. Explorative laparotomy revealed a fibrous capsule encasing intestines as well as dense adhesions between intestinal loops. Since the overall condition of the patient was not well enough to allow a wide dissection and membrane excision, the operation was terminated after performing a limited loop ileostomy. Unfortunately, the patient was lost due to organ failure at the postoperative period. CONCLUSIONS Despite advances in radiological techniques, the exact diagnosis in many cases is still made according to intraoperative findings and histopathological properties of the excised membrane. While some cases of SEP remain asymptomatic for years, most cases are characterized by recurrent bouts of acute, subacute or chronic intestinal obstruction. To our knowledge, the case presented here is the oldest patient with idiopathic SEP in the literature.
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Affiliation(s)
- Ridvan Yavuz
- Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
| | - Sami Akbulut
- Department of Surgery, Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
- Corresponding Author: Sami Akbulut, Department of Surgery, Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey. Tel: +90-4223410660, Fax: +90-4223410036, E-mail:
| | - Mehmet Babur
- Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
| | - Firat Demircan
- Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
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Akbulut S. Accurate definition and management of idiopathic sclerosing encapsulating peritonitis. World J Gastroenterol 2015; 21:675-87. [PMID: 25593498 PMCID: PMC4292304 DOI: 10.3748/wjg.v21.i2.675] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/20/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
AIM To review the literature on idiopathic sclerosing encapsulating peritonitis (SEP), also known as abdominal cocoon syndrome. METHODS The PubMed, MEDLINE, Google Scholar, and Google databases were searched using specific key words to identify articles related to idiopathic SEP. These key words were "sclerosing encapsulating peritonitis," "idiopathic sclerosing encapsulating peritonitis," "abdominal cocoon," and "abdominal cocoon syndrome." The search included letters to the editor, case reports, review articles, original articles, and meeting presentations published in the English-language literature from January 2000 to May 2014. Articles or abstracts containing adequate information about age, sex, symptom duration, initial diagnosis, radiological tools, and surgical approaches were included in the study. Papers with missing or inadequate data were excluded. RESULTS The literature search yielded 73 articles on idiopathic (primary) SEP published in 23 countries. The four countries that published the greatest number of articles were India (n = 21), Turkey (n = 14), China (n = 8) and Nigeria (n = 3). The four countries that reported the greatest number of cases were China (n = 104; 53.88%), India (n = 35; 18.13%), Turkey (n = 17; 8.80%) and Nigeria (n = 5; 2.59%). The present study included 193 patients. Data on age could be obtained for 184 patients (range: 7-87 years; mean ± SD, 34.7 ± 19.2 years), but were unavailable for nine patients. Of the 184 patients, 122 were male and 62 were female; sex data could not be accessed in the remaining nine patients. Of the 149 patients whose preoperative diagnosis information could be obtained, 65 (43.6%) underwent operations for abdominal cocoon, while the majority of the remaining patients underwent operations for a presumed diagnosis of intestinal obstruction and/or abdominal mass. Management information could be retrieved for 115 patients. Of these, 68 underwent excision + adhesiolysis (one laparoscopic); 24 underwent prophylactic appendectomy in addition to excision + adhesiolysis. Twenty patients underwent various resection and repair techniques along with excision + adhesiolysis. The remaining three patients were managed with antituberculosis therapy (n = 2) and immunosuppressive therapy (n = 1). CONCLUSION Idiopathic SEP is a rare disorder characterized by frequently recurring bouts of intestinal obstruction. Surgical therapy is the gold standard management strategy.
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Rehman ZU. Cocoon abdomen - A rare cause of intestinal obstruction. Int J Surg Case Rep 2014; 11:95-97. [PMID: 25951614 PMCID: PMC4446657 DOI: 10.1016/j.ijscr.2014.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/13/2014] [Accepted: 08/30/2014] [Indexed: 11/29/2022] Open
Abstract
Sclerosing encapsulating peritonitis persistent low-grade peritonitis. Most cases are discovered incidentally on laparotomy. Computed tomography or barium meal may be helpful in preoperative diagnosis. Simple removal of the membrane and lysis of the adhesions produces optimal outcome. Bowel resection is indicated only when the intestine is nonviable. A high index of suspicion and appropriate radiology can prevent ‘surprises’ and unnecessary bowel resection.
INTRODUCTION Sclerosing encapsulating peritonitis or abdominal cocoon is a rare condition of unknown etiology in which intestinal obstruction result from encasement of variable length of bowel by dense fibro collagenous membrane. PRESENTATION OF CASE A case of young male is reported who presented with features of small bowel obstruction with tender mass in the right iliac fossa. CT scan suggested features of internal herniation. On exploration, he was found to have small intestine, large intestine, stomach and liver covered with a thick cocoon like membrane. The membrane was gently peeled off the small intestine. The patient recovered well and was discharged on an oral diet. DISCUSSION Preoperative diagnosis of abdominal cocoon is difficult and most cases are discovered incidentally on laparotomy. Contrast enhanced computed tomography or barium meal may be helpful in preoperative diagnosis. Surgical treatment is the main stay of treatment for this condition. Simple removal of the membrane and lysis of the adhesions produces optimal outcome. Bowel resection is indicated only when the intestine is nonviable. CONCLUSION A high index of suspicion and appropriate radiology can prevent ‘surprises’ and unnecessary bowel resection. Simple removal of the membrane gives a good outcome.
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Affiliation(s)
- Zia Ur Rehman
- Department of Surgery, The Aga Khan University Hospital, Stadium Road, Karachi, Pakistan.
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Rasihashemi SZ, Ramouz A, Ebrahimi F. An unusual small bowel obstruction (abdominal cocoon): a case report. ACTA ACUST UNITED AC 2014; 27:82-3. [PMID: 24676306 PMCID: PMC4675476 DOI: 10.1590/s0102-67202014000100019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 04/16/2013] [Indexed: 12/13/2022]
Affiliation(s)
| | - Ali Ramouz
- Medicine Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Faeghe Ebrahimi
- Medicine Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
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Uzunoglu Y, Altintoprak F, Yalkin O, Gunduz Y, Cakmak G, Ozkan OV, Celebi F. Rare etiology of mechanical intestinal obstruction: Abdominal cocoon syndrome. World J Clin Cases 2014; 2:728-731. [PMID: 25405199 PMCID: PMC4233426 DOI: 10.12998/wjcc.v2.i11.728] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/07/2014] [Accepted: 08/31/2014] [Indexed: 02/05/2023] Open
Abstract
Abdominal cocoon syndrome is a rare cause of intestinal obstruction with unknown etiology. Diagnosis of this syndrome, which can be summarized as the small intestine being surrounded by a fibrous capsule not containing the mesothelium, is difficult in the preoperative period. A 47-year-old male patient was referred to the emergency department with complaints of abdominal pain, nausea, and vomiting for two days. The abdominal computed tomography examination detected dilated small intestinal loops containing air-fluid levels clustered in the left upper quadrant of the abdomen and surrounded by a thick, saclike, contrast-enhanced membrane. During exploratory surgery, a capsular structure was identified in the upper left quadrant with a regular surface that was solid-fibrous in nature. Abdominal cocoon syndrome is a rarely seen condition, for which the preoperative diagnosis is difficult. The combination of physical examination and radiological signs, and the knowledge of “recurrent characteristics of the complaints” that can be learned by a careful history, may be helpful in diagnosis.
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Puppala R, Sripathi S, Kadavigere R, Koteshwar P, Singh J. Abdominal cocoon secondary to disseminated tuberculosis. BMJ Case Rep 2014; 2014:bcr-2013-202568. [PMID: 25239980 DOI: 10.1136/bcr-2013-202568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abdominal cocoon, also known as sclerosing encapsulating peritonitis, represents a rare entity where a variable length of the small bowel is enveloped by a fibrocollagenous membrane giving the appearance of a cocoon. It may be asymptomatic and is often diagnosed incidentally at laparotomy. We present a rare case of abdominal cocoon due to abdominal tuberculosis.
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Affiliation(s)
- Radha Puppala
- Department of Radiodiagnosis, Kasturba Medical College, Manipal, Karnataka, India
| | - Smiti Sripathi
- Department of Radiodiagnosis, Kasturba Medical College, Manipal, Karnataka, India
| | - Rajagopal Kadavigere
- Department of Radiodiagnosis, Kasturba Medical College, Manipal, Karnataka, India
| | - Prakashini Koteshwar
- Department of Radiodiagnosis, Kasturba Medical College, Manipal, Karnataka, India
| | - Jyoti Singh
- Malathi Manipal Hospital, Bangalore, Karnataka, India
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Cağlar M, Cetinkaya N, Ozgü E, Güngör T. Persistent ascites due to sclerosing encapsulating peritonitis mimicking ovarian carcinoma: A case report. J Turk Ger Gynecol Assoc 2014; 15:201-3. [PMID: 25317050 DOI: 10.5152/jtgga.2014.37268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 11/02/2013] [Indexed: 12/28/2022] Open
Abstract
Sclerosing encapsulating peritonitis, also known as 'Cocoon Syndrome', is a rare cause of bowel obstruction. The condition might be congenital or acquired and has non-specific symptomatology. Abdominal pain occurs due to the limitation of intestinal motility or segment obstruction by a thick homogenous fibrotic mantle covering the intra-peritoneal organs. Altered peritoneal fluid dynamics result in persistent ascites. Leading pathogenic theories are not well defined, but genetic factors, retrograde trans-tubal flow of causative agents, peritoneal infections, medications and peritoneal invasive procedures are all thought to play a role. There are no specific diagnostic criteria and exact diagnosis is only confirmed during surgery when the investing thick fibrous folds covering the bowel loops are visualised. We present here a case that had been suspected to have an ovarian malignancy due to a huge abdominal heterogeneous mass and ascites on preoperative diagnostic workup, but had a final diagnosis of abdominal Cocoon Syndrome made during surgery.
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Affiliation(s)
- Mete Cağlar
- Department of Obstetrics and Gynecology, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Nilüfer Cetinkaya
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Emre Ozgü
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Tayfun Güngör
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
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Li M, Wang G, Zhou B, Xia X, Li N. Does long intestinal tube splinting aggravate intestinal adhesions? J INVEST SURG 2014; 27:169-75. [PMID: 24785831 DOI: 10.3109/08941939.2013.863986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
OBJECTIVE Long intestinal tube splinting (LITS) is useful for clinically reducing the recurrence of adhesive small bowel obstruction (ASBO). However, a controversy exists whether LITS aggravates intestinal adhesions. This study evaluated the postoperative effects of LITS relative to simple enterolysis on intestinal adhesions in an experimental porcine model. METHODS A porcine model (n = 24) of dense intestinal adhesion was established by abrading the ileal wall with sterile P240 sandpaper. Enterolysis was performed on postoperative day 14. Animals were randomly divided into a group that underwent enterolysis only (control; n = 12) and those who underwent LITS as well as enterolysis (LITS; n = 12). The long intestinal tube was removed on post-LITS day 14, after abdominal radiography. All animals were euthanized on postenterolysis day 28 for assessment of intestinal adhesions using a semiquantitative macroscopic grading scale, hematoxylin-eosin histology, and hydroxyproline assay. RESULTS Prior to enterolysis, the experimentally induced intestinal adhesions of the two groups were similar in extent and severity. On postenterolysis day 28 the LITS and control groups were comparable with regard to adhesion loop length (p = .440), macroscopic adhesion severity (p = .820), serosal fibrosis grading (p = .450), and hydroxyproline content of the adhesion ileal segment (p = .630). CONCLUSION Placement of the long intestinal tube did not aggravate intestinal adhesions over that of simple enterolysis in this intestinal adhesion porcine model.
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Affiliation(s)
- Min Li
- Department of General Surgery, Jinling Hospital, Medicine School of Nanjing University , Nanjing, Jiangsu Province , China
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Nandedkar S, Malukani K, Nayak R, Patidar E. Sclerosing encapsulating peritonitis: a case series. Indian J Gastroenterol 2014; 33:183-7. [PMID: 24214583 DOI: 10.1007/s12664-013-0432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/15/2013] [Indexed: 02/04/2023]
Abstract
Sclerosing encapsulating peritonitis (SEP) is a relatively rare cause of intestinal obstruction characterized by total or partial encapsulation of the small intestine by a thick fibrous membrane and is a difficult preoperative diagnosis. A series of seven cases of SEP is reported. Modalities of preoperative diagnosis along with clinical presentation, operative findings, and histopathology are discussed.
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Affiliation(s)
- Shirish Nandedkar
- Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore Ujjain State Highway, Near MR 10 Crossing, Indore, 453 111, India
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Jovani M, Baticci F, Bonifacio C, Omodei PD, Malesci A. Abdominal cocoon or idiopathic encapsulating peritoneal sclerosis: magnetic resonance imaging. Dig Liver Dis 2014; 46:192-3. [PMID: 24055233 DOI: 10.1016/j.dld.2013.08.136] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 07/31/2013] [Accepted: 08/16/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Manol Jovani
- Department of Gastroenterology, Istituto Clinico Humanitas (ICH) IRCCS, Rozzano, Milan, Italy
| | - Fabio Baticci
- Department of General and Minimally Invasive Surgery, Istituto Clinico Humanitas IRCCS, Rozzano, Milan, Italy
| | - Cristiana Bonifacio
- Department of Radiology, Istituto Clinico Humanitas IRCCS, Rozzano, Milan, Italy
| | - Paolo Dario Omodei
- Department of Gastroenterology, Istituto Clinico Humanitas (ICH) IRCCS, Rozzano, Milan, Italy
| | - Alberto Malesci
- Department of Gastroenterology, Istituto Clinico Humanitas (ICH) IRCCS, Rozzano, Milan, Italy.
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Gong JF, Zhu WM, Yu WK, Li N, Li JS. Conservative treatment of early postoperative small bowel obstruction with obliterative peritonitis. World J Gastroenterol 2013; 19:8722-8730. [PMID: 24379592 PMCID: PMC3870520 DOI: 10.3748/wjg.v19.i46.8722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 10/05/2013] [Accepted: 11/05/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effect of somatostatin and dexamethasone on early postoperative small bowel obstruction with obliterative peritonitis (EPSBO-OP).
METHODS: This prospective randomized study included 70 patients diagnosed with EPSBO-OP from June 2002 to January 2009. Patients were randomized into two groups: a control group received total parenteral nutrition and nasogastric (NG) tube feeding; and an intervention group received, in addition, somatostatin and dexamethasone treatment. The primary endpoints were time to resolution of bowel obstruction and length of hospital stay, and the secondary endpoints were daily NG output and NG feeding duration, treatment-related complications, postoperative obstruction relapse, and patient satisfaction.
RESULTS: Thirty-six patients were allocated to the intervention group and 34 to the control group. No patient needed to undergo surgery. Patients in the intervention group had an earlier resolution of bowel obstruction (22.4 ± 9.1 vs 29.9 ± 10.1 d, P = 0.002). Lower daily NG output (583 ± 208 vs 922 ± 399 mL/d, P < 0.001), shorter duration of NG tube use (16.7 ± 8.8 vs 27.7 ± 9.9 d, P < 0.001), and shorter length of hospital stay (25.8 vs 34.9 d, P = 0.001) were observed in the intervention group. The rate of treatment-related complications (P = 0.770) and relapse of obstruction (P = 0.357) were comparable between the two groups. There were no significant differences in postoperative satisfaction at 1, 2 and 3 years between the two groups.
CONCLUSION: Somatostatin and dexamethasone for EPSBO-OP promote resolution of obstruction and shorten hospital stay, and are safe for symptom control without increasing obstruction relapse.
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Warner B, Davies B, Joshi D, Cairns S, Austin M. An unusual cause of vomiting. Clin Med (Lond) 2013; 13:522-3. [PMID: 24115717 PMCID: PMC4953811 DOI: 10.7861/clinmedicine.13-5-522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ben Warner
- Department of Gastroenterology, Digestive Diseases Centre, Royal Sussex County Hospital, Brighton, UK
| | - Beth Davies
- Department of Gastroenterology, Digestive Diseases Centre, Royal Sussex County Hospital, Brighton, UK
| | - Deepak Joshi
- Department of Gastroenterology, Digestive Diseases Centre, Royal Sussex County Hospital, Brighton, UK
| | - Stuart Cairns
- Department of Gastroenterology, Digestive Diseases Centre, Royal Sussex County Hospital, Brighton, UK
| | - Mark Austin
- Department of Gastroenterology, Digestive Diseases Centre, Royal Sussex County Hospital, Brighton, UK
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Wang YZ, King H, Diebold A. Cocoon formation in patients with midgut neuroendocrine tumors: a rare and unrecognized final pathway. Pancreas 2013; 42:944-8. [PMID: 23587852 DOI: 10.1097/mpa.0b013e318287ce77] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Neuroendocrine tumors (NETs) are relatively rare with an indolent nature. As a result, treatment is often delayed and passive. The most commonly recognized disease progression leading to death is from the sequelae of bowel obstruction, ischemia, or liver failure secondary to liver metastasis. We recently recognized a rare cocoon-like formation in patients with metastatic gastroenteropancreatic NETs and hypothesize that this may be a distinct, final pathway for these patients. METHODS Ten patients with stage IV gastroenteropancreatic NETs, seen at our center between October 2008 and November 2011, who developed a cocoon were identified. Patient's charts, operative reports, pathology, and tumor markers were reviewed. RESULTS No discernable predictors were identified as precursors to this condition. One patient survived 13 months after cocoon diagnosis, and the remaining 9 patients were all deceased within 5 months. Surgical treatment was attempted in 6 patients and was only partially successful in 1 patient who had the earliest stage of cocoon formation (type 1). CONCLUSIONS Cocoon-like formations in patients with stage IV gastroenteropancreatic NETs is rare and may be a terminal disease progression that has not been previously recognized. The best treatment option remains unknown. Surgical treatment is not advisable, with the exception of type 1 abdominal cocoons.
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Affiliation(s)
- Yi-Zarn Wang
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
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Small Bowel Injury in Peritoneal Encapsulation following Penetrating Abdominal Trauma. Case Rep Surg 2013; 2013:379464. [PMID: 23533912 PMCID: PMC3600322 DOI: 10.1155/2013/379464] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/13/2013] [Indexed: 02/07/2023] Open
Abstract
Small bowel encapsulation is a rare entity which is usually found incidentally at autopsy. We report the first case of peritoneal encapsulation encountered serendipitously at laparotomy undertaken for penetrating abdominal trauma and review the literature on peritoneal encapsulation. We also compare this phenomenon to abdominal cocoon and sclerosing encapsulating peritonitis.
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