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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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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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Lasheen O, ElKorety M. Abdominal Cocoon or Encapsulating Peritoneal Sclerosis: A Rare Cause of Small Bowel Obstruction. Eur J Case Rep Intern Med 2020; 7:001972. [PMID: 33313011 PMCID: PMC7727638 DOI: 10.12890/2020_001972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 09/11/2020] [Indexed: 01/01/2023] Open
Abstract
Encapsulating peritoneal sclerosis (EPS), also known as abdominal cocoon syndrome (AC) or sclerosing encapsulating peritonitis (SEP), is an uncommon condition typically presenting with features of bowel obstruction. We present the case of a 41-year-old male patient who presented to the accident and emergency department with a 7-day history of abdominal pain. Contrast CT of the abdomen and pelvis was ordered and was suggestive of small bowel obstruction involving most of the small bowel with no apparent transition point. Laparotomy showed a tough whitish fibrous membrane encasing the entire length of the small bowel. Advances in CT have made diagnosis possible before a decision on surgical intervention is made.
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Affiliation(s)
- Omar Lasheen
- General Surgery Department, Royal Oldham Hospital, Pennine Acute Trust, Manchester, UK
| | - Mohamed ElKorety
- General Surgery Department, West Hertfordshire Hospitals NHS Trust, Hertfordshire, UK
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Zhang Z, Zhang M, Li L. Sclerosing encapsulating peritonitis: three case reports and review of the literature. J Int Med Res 2020; 48:300060520949104. [PMID: 32811273 PMCID: PMC7441290 DOI: 10.1177/0300060520949104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is a disease that is rarely encountered clinically. Preoperative diagnosis of SEP can be difficult. However, with imaging technology, such as computed tomography (CT), this condition can be diagnosed without surgery and pathological analysis. SEP is characterized by small intestine being partially or completely encased by a layer of a thick grayish-white fibrocollagenous membrane similar to a cocoon. The most common symptoms of SEP are abdominal pain, nausea, and vomiting. SEP often leads to intestinal obstruction. Our hospital treated three emergency patients who complained of acute or chronic abdominal pain. CT showed "cauliflower sign" in two cases. The three patients were diagnosed with SEP intraoperatively. In a female patient with ascites, the situation was extremely serious, and this condition had not been reported in detail previously. Fortunately, all patients were discharged without complications. We should pay special attention to patients with SEP who have ascites, which indicates a serious situation.
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Affiliation(s)
- Zhenbin Zhang
- Department of Gastrointestinal Surgery, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Menglai Zhang
- Department of Gastrointestinal Surgery, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Ling Li
- Department of Intensive Care Unit, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
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Yu R, Ya Y, Ni X, Fan G. Imaging and treatment of idiopathic abdominal cocoon in 9 patients. Exp Ther Med 2019; 19:651-657. [PMID: 31885704 PMCID: PMC6913277 DOI: 10.3892/etm.2019.8258] [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: 04/13/2019] [Accepted: 11/01/2019] [Indexed: 01/01/2023] Open
Abstract
The aim of the current study was to investigate the imaging features of abdominal cocoon (AC), the methods of diagnosis and treatment of AC and improve understanding of AC. To do this, the current study retrospectively analyzed the clinical data and imaging findings of nine patients with AC. The clinical manifestations included intestinal obstruction in six out of the nine cases of AC, which included two cases of bowel strangulation and five cases of soft masses in the abdomen. Imaging features of AC included the following: i) Bowel loops were usually present in a fixed cluster; ii) bowel loops were encapsulated partially or totally by a thickening fibrous membrane-like ‘cocoon’; iii) bowel wall thickened in the ‘cocoon’, and the bowel loops and sac adhered; iv) loculated ascites in the ‘cocoon’; v) abnormal clustering of the mesenteric vasculature, hypoplasia of the omentum majus was present or absent; and vi) Ileus occurred in some cases. The features of a plain abdominal X-ray, a gastrointestinal barium meal series and ultrasonography lacked specificity. The results of CT in eight out of nine cases of AC were consistent with the surgical findings. Surgery was the first choice of therapy. All cases were treated surgically, showing that the bowel loops were encapsulated partially or totally by a thickened fibrous membrane. All cases received operations including partial or total excision of the membrane and enterolysis. In conclusion, CT may be highly valuable in the preoperative diagnosis of AC.
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Affiliation(s)
- Rui Yu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Yang Ya
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Xiaoqiong Ni
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
| | - Guohua Fan
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, P.R. China
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Banday M, Rauof S. Secondary encapsulating peritonitis: a study of cases over five years. Turk J Surg 2019; 35:171-177. [PMID: 32550324 PMCID: PMC6795221 DOI: 10.5578/turkjsurg.4143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/24/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Cocoon abdomen or sclerosing encapsulating peritonitis is a rare condition characterized by bowel entrapment in a cocoon-like membrane. Primary and secondary types have been described. Most patients present acutely with intestinal obstruction or peritonitis but history of long standing chronic symptoms may be present. The condition is usually not detected on imaging, and diagnosis at laparotomy is common. Surgical treatment includes excision of the membrane with adhesiolysis. MATERIAL AND METHODS A 5-year study of the patients operated for cocoon abdomen in our hospital was conducted. Analysis of patient symptoms, imaging findings, intra-operative findings and histopathology was carried out. RESULTS Five males and three females were included into the study. Mean age was 29.6 years. Five patients presented with acute intestinal obstruction and three patients with perforation peritonitis. Laparotomy was performed in all cases. Successful excision of the membrane was done in all patients of obstruction while membrane excision could only be done in one patient of peritonitis. Histopathology revealed tuberculosis in six patients, one patient was already on anti-tubercular treatment and one patient had carcinoma. There was one mortality. CONCLUSION Cocoon abdomen is a rare condition. Tuberculosis should always be considered as a cause in endemic areas. Surgery is the preferred treatment and involves excision of the membrane but can be difficult in patients with superadded peritonitis or malignancy.
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Affiliation(s)
- Mansoor Banday
- Department of General Surgery, Esi Postgraduate Institute of Medical Sciences and Research and Hospital, Basaidarapur, New Delhi, India
| | - Sehrish Rauof
- Department of Nephrology, Government Medical College, Srinagar, India
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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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Acar T, Kokulu İ, Acar N, Tavusbay C, Hacıyanlı M. Idiopathic encapsulating sclerosing peritonitis. ULUSAL CERRAHI DERGISI 2015; 31:241-3. [PMID: 26668535 DOI: 10.5152/ucd.2015.2786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/05/2014] [Indexed: 12/28/2022]
Abstract
Sclerosing encapsulating peritonitis (SEP)/abdominal cocoon syndrome is a rare condition that is generally identified in young females. The exact cause is still unknown. Timely and accurate imaging and diagnosis play a critical role for morbidity and mortality. It is usually diagnosed during surgery. The initial treatment should be conservative, and aggressive surgical approach should be avoided as much as possible. Herein, we aimed to review the clinical features of SEP based on a patient who underwent surgery in our clinic.
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Affiliation(s)
- Turan Acar
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - İbrahim Kokulu
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Nihan Acar
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Cengiz Tavusbay
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Mehmet Hacıyanlı
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
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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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Naniwadekar RG, Kulkarni SR, Bane P, Agrarwal S, Garje A. Abdominal cocoon: an unusual presentation of small bowel obstruction. J Clin Diagn Res 2014; 8:173-4. [PMID: 24701524 DOI: 10.7860/jcdr/2014/6514.4049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 12/21/2013] [Indexed: 12/18/2022]
Abstract
Abdominal cocoon is a rare condition. It presents as a thick whitish membrane which covers bowel loops. Because of this presentation, it is also called as sclerosing encapsulating peritonitis. It is usually diagnosed intra operatively. Treatment of this condition involves resection of the membrane and release of adhesions. Pre-operatively, patient is investigated for recurrent episodes of small bowel obstructions. However, preoperative diagnosis does not change the treatment and management. Investigations done preoperatively help in expediting the treatment with planned laparotomy.
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Affiliation(s)
- R G Naniwadekar
- Consultant, Department of General Surgery, Krishna Institute of Medical Sciences and Research Centre , Maharashtra, India
| | - S R Kulkarni
- Consultant, Department of General Surgery, Krishna Institute of Medical Sciences and Research Centre , Maharashtra, India
| | - P Bane
- Resident, Department of General Surgery, Krishna Institute of Medical Sciences and Research Centre , Maharashtra, India
| | - S Agrarwal
- Resident, Department of General Surgery, Krishna Institute of Medical Sciences and Research Centre , Maharashtra, India
| | - A Garje
- Resident, Department of General Surgery, Krishna Institute of Medical Sciences and Research Centre , Maharashtra, India
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Tannoury JN, Abboud BN. Idiopathic sclerosing encapsulating peritonitis: Abdominal cocoon. World J Gastroenterol 2012; 18:1999-2004. [PMID: 22563185 PMCID: PMC3342596 DOI: 10.3748/wjg.v18.i17.1999] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 02/20/2012] [Accepted: 02/26/2012] [Indexed: 02/06/2023] Open
Abstract
Abdominal cocoon, the idiopathic form of sclerosing encapsulating peritonitis, is a rare condition of unknown etiology that results in an intestinal obstruction due to total or partial encapsulation of the small bowel by a fibrocollagenous membrane. Preoperative diagnosis requires a high index of clinical suspicion. The early clinical features are nonspecific, are often not recognized and it is difficult to make a definite pre-operative diagnosis. Clinical suspicion may be generated by the recurrent episodes of small intestinal obstruction combined with relevant imaging findings and lack of other plausible etiologies. The radiological diagnosis of abdominal cocoon may now be confidently made on computed tomography scan. Surgery is important in the management of this disease. Careful dissection and excision of the thick sac with the release of the small intestine leads to complete recovery in the vast majority of cases.
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