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Muacevic A, Adler JR, Shah A, Allu VJC. Congenital Peritoneal Encapsulation: A Literature Review of a Rare Pathology. Cureus 2022; 14:e31765. [PMID: 36569734 PMCID: PMC9772582 DOI: 10.7759/cureus.31765] [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: 11/21/2022] [Indexed: 11/23/2022] Open
Abstract
Congenital peritoneal encapsulation (CPE) is a rare, congenital entity in which an accessory peritoneal membrane surrounds the small bowel. This condition is usually asymptomatic and rarely causes intestinal obstruction. Despite the rare cause of intestinal obstruction, it has excellent post-operative recovery. There is no gold standard approach for investigating CPE; however, a computerized tomography scan of the abdomen might be helpful. Furthermore, diagnostic laparoscopy could be considered an adjunct. This report highlights the rare congenital anomaly as a cause of intestinal obstruction.
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Dave A, McMahon J, Zahid A. Congenital peritoneal encapsulation: A review and novel classification system. World J Gastroenterol 2019; 25:2294-2307. [PMID: 31148901 PMCID: PMC6529893 DOI: 10.3748/wjg.v25.i19.2294] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/23/2019] [Accepted: 03/30/2019] [Indexed: 02/06/2023] Open
Abstract
Congenital peritoneal encapsulation (CPE) is a very rare, congenital condition characterised by the presence of an accessory peritoneal membrane which encases a variable extent of the small bowel. It is unclear how CPE develops, however it is currently understood to be a result of an aberrant adhesion in the peritoneal lining of the physiological hernia in foetal mid-gut development. The condition was first described in 1868, and subsequently there have been only 45 case reports of the phenomenon. No formal, systematised review of CPE has yet been performed, meaning the condition remains poorly understood, underdiagnosed and mismanaged. Diagnosis of CPE remains clinical with important adjuncts provided by imaging and diagnostic laparoscopy. Two thirds of patients present with abdominal pain, likely secondary to sub-acute bowel obstruction. A fixed, asymmetrical distension of the abdomen and differential consistency on abdominal palpation are more specific clinical features present in approximately 10% of cases. CPE is virtually undetectable on plain imaging, and is only detected on 40% of patients with computed tomography scan. Most patients will undergo diagnostic laparotomy to confirm the diagnosis. Management of CPE includes both medical management of the critically-unstable patient and surgical laparotomy, partial peritonectomy and adhesiolysis. Prognosis following prompt surgical treatment is excellent, with a majority of patients being symptom free at follow up. This review summarises the current literature on the aetiology, diagnosis and treatment of this rare disease. We also introduce a novel classification system for encapsulating bowel diseases, which may distinguish CPE from the commoner, more morbid conditions of abdominal cocoon and encapsulating peritoneal sclerosis.
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Affiliation(s)
- Aneesh Dave
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown 2050, New South Wales, Australia
- Sydney Medical School, Edward Ford Building, the University of Sydney, Camperdown 2006, New South Wales, Australia
| | - James McMahon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown 2050, New South Wales, Australia
| | - Assad Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown 2050, New South Wales, Australia
- Sydney Medical School, Edward Ford Building, the University of Sydney, Camperdown 2006, New South Wales, Australia
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Renko AE, Mirkin KA, Cooper AB. Peritoneal encapsulation: a rare cause of small bowel obstruction. BMJ Case Rep 2019; 12:12/4/e228594. [PMID: 30992285 DOI: 10.1136/bcr-2018-228594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Peritoneal encapsulation syndrome (PES) is a rare cause of small bowel obstruction (SBO) in patients with no prior history of abdominal surgery. First described by Cleland in 1868, PES is a congenital condition characterised by small bowel encasement in an accessory, but otherwise normal peritoneal membrane. 1 2 A result of abnormal rotation of the midgut during early development, the condition causes fibrous encapsulation of the intestines, thus preventing bowel distention.3 While preoperative diagnosis is difficult, several case reports have described clinical and imaging signs that can help clinicians with not only recognising the condition but also preparing appropriately for perioperative discovery of anatomical variants. 3 4.
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Affiliation(s)
- Abagayle E Renko
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Katelin A Mirkin
- Department of Surgery, Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Amanda B Cooper
- Department of Surgery, Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
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Idiopathic Sclerosing Encapsulating Peritonitis: A Rare Cause of Subacute Intestinal Obstruction. Case Rep Med 2016; 2016:8206894. [PMID: 27642301 PMCID: PMC5014933 DOI: 10.1155/2016/8206894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 08/07/2016] [Indexed: 12/21/2022] Open
Abstract
We present a case of a previously healthy 50-year-old gentleman who had recurrent vomiting and abdominal pain of two-month duration. The patient was subsequently diagnosed with abdominal cocoon on computed tomography. Idiopathic sclerosing encapsulating peritonitis, also known as abdominal cocoon, is a rare cause of small bowel obstruction. Visualization of variable encasement of the small bowel loops by a characteristic membranous sac, either preoperatively with cross-sectional imaging or intraoperatively, is the key to diagnosis. This is a highly treatable condition; surgical excision of the sac with adhesiolysis facilitates a full recovery in affected patients.
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Congenital peritoneal encapsulation of the small intestine: A rare case report. Int J Surg Case Rep 2016; 27:28-31. [PMID: 27522401 PMCID: PMC4987511 DOI: 10.1016/j.ijscr.2016.07.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/25/2016] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Peritoneal Encapsulation (PE) is a scarce congenital malformation, characterized by a supplementary peritoneal membrane that covers all or a part of the small intestine. PRESENTATION OF CASE PE was unexpectantly discovered in a young woman during laparotomy for bowel obstruction. There were no specific pre-operative indications of this malformation. The operation was uneventful. DISCUSSION PE is a very rare congenital anatomical anomaly that is difficultly identified pre-operatively. PE is mainly asymptomatic, but in some cases, like in the presented one, PE presents with small bowel obstruction. Surgeons should be aware of this malformation and suspect it when encountering a patient with small bowel obstruction without other etiological factors. CONCLUSION Knowledge of this peculiar congenital anomaly is pivotal, so that accurate diagnosis and appropriate management of it are direct and efficient.
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Teixeira D, Costa V, Costa P, Alpoim C, Correia P. Congenital peritoneal encapsulation. World J Gastrointest Surg 2015; 7:174-7. [PMID: 26328038 PMCID: PMC4550845 DOI: 10.4240/wjgs.v7.i8.174] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 06/05/2015] [Accepted: 06/18/2015] [Indexed: 02/07/2023] Open
Abstract
Peritoneal encapsulation (PE) is a rare congenital malformation, characterized by a thin accessory peritoneal membrane which covers all or part of the small bowel, forming an accessory peritoneal sac. Most cases are asymptomatic and diagnosed incidentally during surgery and/or autopsy. Clinical presentation with intestinal obstruction is extremely rare and we report a case. A 25-year-old male, referred to emergency department with diffuse abdominal pain, crampy, with 8 h evolution, associated with nausea, vomiting and constipation in the last 48 h. The abdominal examination revealed an asymmetric and fixed distension, with hard consistency on palpation of lower abdominal quadrants. The abdominal radiography reveals a small bowel distension and fluid levels. Submitted to laparoscopic surgery that recourse to conversion because there is a total peritoneal encapsulation of the small bowel. After opening the peritoneal sac, we find a rotation of mesentery, at its root, conditioning twisting of small bowel and consequently occlusion. Uneventful postoperative with discharged at the 6th day. The PE is a very rare congenital anomaly characterized by abnormal bowel back into the abdominal cavity in the early stages of development. Your knowledge becomes important because, although rare, it might be diagnosis in patients with intestinal obstruction, in the absence of other etiologic factors.
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Affiliation(s)
- Diana Teixeira
- Diana Teixeira, Vítor Costa, Paula Costa, Carlos Alpoim, Pinto Correia, General Surgery Department, Centro Hospitalar do Alto Ave, 4800 Guimarães, Portugal
| | - Vítor Costa
- Diana Teixeira, Vítor Costa, Paula Costa, Carlos Alpoim, Pinto Correia, General Surgery Department, Centro Hospitalar do Alto Ave, 4800 Guimarães, Portugal
| | - Paula Costa
- Diana Teixeira, Vítor Costa, Paula Costa, Carlos Alpoim, Pinto Correia, General Surgery Department, Centro Hospitalar do Alto Ave, 4800 Guimarães, Portugal
| | - Carlos Alpoim
- Diana Teixeira, Vítor Costa, Paula Costa, Carlos Alpoim, Pinto Correia, General Surgery Department, Centro Hospitalar do Alto Ave, 4800 Guimarães, Portugal
| | - Pinto Correia
- Diana Teixeira, Vítor Costa, Paula Costa, Carlos Alpoim, Pinto Correia, General Surgery Department, Centro Hospitalar do Alto Ave, 4800 Guimarães, Portugal
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Kaur S, Doley RP, Chabbhra M, Kapoor R, Wig J. Post trauma abdominal cocoon. Int J Surg Case Rep 2014; 7C:64-5. [PMID: 25590647 PMCID: PMC4336413 DOI: 10.1016/j.ijscr.2014.10.081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 10/21/2014] [Accepted: 10/22/2014] [Indexed: 12/31/2022] Open
Abstract
Patient with past history of abdominal blunt trauma presented with subacute intestinal obstruction caused by abdominal cocoon. Common aetiology for abdominal cocoon is subclinical peritonitis, in this case due to an unnoticed injury during blunt trauma. Diagnosis can made preoperatively with imaging. Treatment by adhesiolysis in obstructed cases. Recurrences are uncommon.
Abdominal cocoon or sclerosing peritonitis refers to a rare cause of intestinal obstruction due to formation of a membrane encasing the bowel. We report a case of abdominal cocoon post blunt trauma abdomen. The patient presented with a history of subacute intestinal obstruction and a mobile abdomen lump. Abdominal cocoon was diagnosed on computed tomography. He underwent adhesiolysis with excision of membrane.
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Affiliation(s)
- Supreet Kaur
- Department of General Surgery, Fortis Hospital, Mohali, Punjab, India.
| | | | | | - Rajeev Kapoor
- Department of General Surgery, Fortis Hospital, Mohali, Punjab, India
| | - Jaidev Wig
- Department of General Surgery, Fortis Hospital, Mohali, Punjab, India
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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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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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