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Bourabaa S, Bourouail O, Mansouri A, Zhim M, Echarrab E, El Alami H. Acute presentation of cocoon abdomen as intestinal obstruction mimicking with strangulated eventration: A case report. Int J Surg Case Rep 2024; 119:109673. [PMID: 38692122 PMCID: PMC11077024 DOI: 10.1016/j.ijscr.2024.109673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/06/2024] [Accepted: 04/19/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION Abdominal cocoon syndrome (ACS), or 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. While cocooning of the abdomen primarily manifests in individuals undergoing peritoneal dialysis (PD), it has also been reported to occur spontaneously. Remarkably rare, SEP may present with complete mechanical bowel obstruction in select cases. CASE PRESENTATION We hereby report a case of an 87-year-old female patient with a prior history of abdominal surgery, who presented to our emergency department with a clinical picture of complete small bowel obstruction. Clinical and radiological data were suggestive of a strangulated midline hernia, prompting a therapeutic laparotomy. The surgical exploration revealed the encasement of the small bowel loops within a thick fibrocollagenous membrane. Efficient resolution was achieved through skillful adhesiolysis and the meticulous excision of the fibrocollagenous membrane. DISCUSSION SEP is more prevalent in men, with a higher incidence observed in tropical and subtropical countries. While the precise pathophysiology remains elusive, it is hypothesized that subclinical intraabdominal inflammation gives rise to the formation of a dense fibrocollagenous membrane. This membrane encapsulates intraperitoneal organs, ultimately leading to intestinal obstruction. Patients typically present with a recurrent history of small bowel obstruction, notably in the absence of prior abdominal surgery. Abdominal CT scan with experienced radiologist interpretation can aid in preoperative diagnosis. In cases where non-operative management fails and recurrent obstructions persist, surgical adhesiolysis stands as the well-established gold standard. CONCLUSION SEP is a rare abdominal disease, posing challenges for preoperative diagnosis. Laparotomy plays an important role in its diagnosis and treatment. The primary objective of the surgical intervention is to release the encapsulation of the bowel and safeguard the optimal functioning of the small intestines as much as possible.
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Affiliation(s)
- S Bourabaa
- Emergency General Surgery Department, Ibn Sina Hospital, Rabat, Morocco; Mohamed V University, Rabat, Morocco.
| | - O Bourouail
- Emergency General Surgery Department, Ibn Sina Hospital, Rabat, Morocco; Mohamed V University, Rabat, Morocco
| | - A Mansouri
- Emergency General Surgery Department, Ibn Sina Hospital, Rabat, Morocco; Mohamed V University, Rabat, Morocco
| | - M Zhim
- Radiology Department, Ibn Sina Hospital, Rabat, Morocco; Mohamed V University, Rabat, Morocco
| | - E Echarrab
- Emergency General Surgery Department, Ibn Sina Hospital, Rabat, Morocco; Mohamed V University, Rabat, Morocco
| | - H El Alami
- Emergency General Surgery Department, Ibn Sina Hospital, Rabat, Morocco; Mohamed V University, Rabat, Morocco
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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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Alzarooni HA, Ribeiro Junior MAF, Iddris SA, Alhammadi HB, DeSoucy ES, Alsayari AA. Sclerosing encapsulating peritonitis: A rare cause of small bowel obstruction. Int J Surg Case Rep 2023; 112:108959. [PMID: 37879291 PMCID: PMC10667872 DOI: 10.1016/j.ijscr.2023.108959] [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: 09/21/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Sclerosing encapsulating peritonitis (SEP), also known as abdominal cocoon syndrome, represents a rare cause of small bowel obstruction. CASE PRESENTATION Herein we report an uncommon case of small bowel obstruction caused by SEP in a 30-year-old male with no prior surgical history who presented to the emergency department. The patient was diagnosed with SEP on preoperative CT scan and underwent a therapeutic laparotomy with extensive adhesiolysis. His symptoms resolved postoperatively and he was discharged in a good condition. DISCUSSION Sclerosing encapsulating peritonitis is more prevalent in men, and has a higher incidence in tropical and subtropical countries. The exact pathophysiology of the disease in not well understood, but subclinical intra-abdominal inflammation is theorized to result in a thick fibrocollagenous membrane encapsulating intra-peritoneal organs which leads to intestinal obstruction. The disease is categorized into primary and secondary SEP depending on identification of a pathologic factor. It is further divided into 3 sub-types according to the extent of the peritoneal membrane encasement observed intra-operatively. Patients often present with recurrent history of small bowel obstruction in the absence of prior abdominal surgery. Computed tomography of the abdomen with experienced radiologist interpretation can aid in preoperative diagnosis. In patients with recurrent obstructions and failure of non-operative management, surgical adhesiolysis remains the gold standard. CONCLUSION Sclerosing encapsulating peritonitis, is a rare cause of small bowel obstruction. The exact pathogenesis is not well understood. The main line of treatment is surgical adhesiolysis and excision of the intra-abdominal fibrocollagenous membrane.
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Affiliation(s)
- Hamda A Alzarooni
- Sheikh Shakhbout Medical City, Mayo Clinic Abu Dhabi, United Arab Emirates.
| | - Marcelo A F Ribeiro Junior
- Trauma, Critical Care and Acute Care Surgery, Sheikh Shakhbout Medical City, Mayo Clinic Abu Dhabi, United Arab Emirates; Khalifa University and Gulf Medical University, United Arab Emirates; Catholic University of Sao Paulo, Campus Sorocaba, Brazil
| | - Samirah A Iddris
- Sheikh Shakhbout Medical City, Mayo Clinic Abu Dhabi, United Arab Emirates
| | - Hamad B Alhammadi
- Sheikh Shakhbout Medical City, Mayo Clinic Abu Dhabi, United Arab Emirates
| | - Erik S DeSoucy
- Trauma, Critical Care and Acute Care Surgery, Sheikh Shakhbout Medical City, Mayo Clinic Abu Dhabi, United Arab Emirates; Uniformed Services University, United States.
| | - Ahmed A Alsayari
- Trauma, Critical Care and Acute Care Surgery, Division Chair General Surgery, Sheikh Shakhbout Medical City, Mayo Clinic Abu Dhabi, United Arab Emirates
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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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Mehmood M, Mirza AA, Sree GS, Vakkalagadda NP, Mumtaz H. Abdominal cocoon syndrome. A rare cause of mechanical intestinal obstruction: A case report. Int J Surg Case Rep 2023; 103:107875. [PMID: 36682283 PMCID: PMC9876940 DOI: 10.1016/j.ijscr.2023.107875] [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: 12/01/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Abdominal Cocoon Syndrome (ACS) also known as Idiopathic. Sclerosing Peritonitis, is a rare cause of Mechanical Intestinal Obstruction. CASE PRESENTATION We present a 59-year-old man with severe intestinal blockage symptoms for three days. Rectum had a noticeable amount of abdominal fat. To rule out the more common causes of mechanical blockage, a CT scan revealed the presence of a rare condition called Cocoon Syndrome, which necessitated exploratory laparotomy and adhesiolysis surgery. After the surgery, the patient was declared stable and was released from the hospital. CLINICAL DISCUSSION The diagnosis of a tuberculous abdominal cocoon before surgery is a real challenge. CONCLUSION Recognizing and understanding this entity, as well as the usual radiological findings, may help in its appropriate treatment.
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Affiliation(s)
| | | | - Gummadi Sai Sree
- Government General hospital, Guntur medical college, Guntur, India
| | | | - Hassan Mumtaz
- Clinical Research Associate: Maroof International Hospital, Public Health Scholar: Health Services Academy, Pakistan.
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Mousavi MA, Shaghaghi A, Sabouri M, Yousefian R. Abdominal cocoon syndrome as rare cause of intestinal obstruction: A case report. Int J Surg Case Rep 2022; 98:107547. [PMID: 36057246 PMCID: PMC9482919 DOI: 10.1016/j.ijscr.2022.107547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/21/2022] [Accepted: 08/21/2022] [Indexed: 02/07/2023] Open
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Keese D, Schmedding A, Saalabian K, Lakshin G, Fiegel H, Rolle U. Abdominal cocoon in children: A case report and review of literature. World J Gastroenterol 2021; 27:6332-6344. [PMID: 34712036 PMCID: PMC8515801 DOI: 10.3748/wjg.v27.i37.6332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/30/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Abdominal cocoon or “encapsulating peritoneal sclerosis” (EPS) is an uncommon and rare cause of intestinal obstruction. Only a few cases have been reported in paediatric patients. Typically, EPS is described as the primary form in young adolescent girls from tropical and subtropical countries because of viral peritonitis due to retrograde menstruation or a history of peritoneal dialysis. Most patients are asymptomatic or present with abdominal pain, which is likely to occur secondary to subacute bowel obstruction. Findings at imaging, such as ultrasound, computed tomography, and magnetic resonance imaging, are often nonspecific. When diagnosed, EPS is characterized by total or partial encasement of the bowel within a thick fibrocollagenous membrane that envelopes the small intestine in the form of a cocoon because of chronic intraabdominal fibroinflammatory processes. The membrane forms a fibrous tissue sheet that covers, fixes, and finely constricts the gut, compromising its motility.
CASE SUMMARY We present a case of EPS in a 12-year-old boy 8 wk after primary surgery for resection of symptomatic jejunal angiodysplasia. There was no history of peritoneal dialysis or drug intake.
CONCLUSION In this report, we sought to highlight the diagnostic, surgical, and histopathological characteristics and review the current literature on EPS in paediatric patients.
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Affiliation(s)
- Daniel Keese
- Goethe-University Frankfurt, Department of Paediatric Surgery and Paediatric Urology, University Hospital, Frankfurt 60590, Germany
| | - Andrea Schmedding
- Goethe-University Frankfurt, Department of Paediatric Surgery and Paediatric Urology, University Hospital, Frankfurt 60590, Germany
| | - Kerstin Saalabian
- Goethe-University Frankfurt, Department of Paediatric Surgery and Paediatric Urology, University Hospital, Frankfurt 60590, Germany
| | - Georgy Lakshin
- Goethe-University Frankfurt, Department of Paediatric Surgery and Paediatric Urology, University Hospital, Frankfurt 60590, Germany
| | - Henning Fiegel
- Goethe-University Frankfurt, Department of Paediatric Surgery and Paediatric Urology, University Hospital, Frankfurt 60590, Germany
| | - Udo Rolle
- Goethe-University Frankfurt, Department of Paediatric Surgery and Paediatric Urology, University Hospital, Frankfurt 60590, Germany
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Karona P, Blevrakis E, Kastanaki P, Tzouganakis A, Kastanakis M. Abdominal Cocoon Syndrome: An Extremely Rare Cause of Small Bowel Obstruction. Cureus 2021; 13:e14351. [PMID: 33972908 PMCID: PMC8105234 DOI: 10.7759/cureus.14351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Abdominal cocoon syndrome or encapsulating peritoneal sclerosis is a rare condition causing small bowel obstruction. It is called cocoon syndrome because of the existence of an abnormal membrane that contains part or the entire small intestine. We present a case of a 49-year-old male, presenting to our department with recurrent episodes of obstructive ileus that did not respond to conservative treatment. He underwent exploratory laparotomy and a thick membrane covering the small bowel loops was found. The membrane was excised and sent for pathological examination. Abdominal cocoon syndrome is an acquired condition caused by an inflammatory process that is not yet completely understood. There are many theories for the pathophysiology of the disease. In most cases, the diagnosis is established during surgery. Complete removal of the membrane is the indicated surgical treatment. In mild cases, when the diagnosis is made preoperatively, conservative treatment should be the first choice.
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Affiliation(s)
- Paraskevi Karona
- First Department of Surgery, Saint George General Hospital of Chania, Chania, GRC
| | - Evangelos Blevrakis
- Pediatric Surgery Department, Saint George General Hospital of Chania, Chania, GRC
| | - Pagona Kastanaki
- First Department of Surgery, Saint George General Hospital of Chania, Chania, GRC
| | - Aggelos Tzouganakis
- First Department of Surgery, Saint George General Hospital of Chania, Chania, GRC
| | - Miltiades Kastanakis
- First Department of Surgery, Saint George General Hospital of Chania, Chania, GRC
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9
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Mekann Bouv-Hez M, Charissoux A, Bouvier S, Mathonnet M, Christou N. From abdominal pain to a diagnosis of primary sclerosing encapsulating peritonitis and its management, a case report. Acta Chir Belg 2021; 122:420-423. [PMID: 33502964 DOI: 10.1080/00015458.2021.1881333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Sclerosing Encapsulating peritonitis (SEP) is a rare chronic fibro-inflammatory disease of the peritoneum. The aetiology can be either primary or secondary. The knowledge around this topic is poor. CASE PRESENTATION Based on the report of a 64-year-old man suffering from intestinal obstruction and its management with a final diagnosis of primary SEP, herein we review the literature concerning this specific entity of primary SEP and its challenge in both diagnosis and treatment. CONCLUSION whereas SEP is a rare entity, imagery is helpful to make the diagnosis.
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Affiliation(s)
| | | | - Stephane Bouvier
- Service de chirurgie digestive, endocrinienne et générale, CHU de Limoges, Limoges, France
| | - Muriel Mathonnet
- Service de chirurgie digestive, endocrinienne et générale, CHU de Limoges, Limoges, France
| | - Niki Christou
- Service de chirurgie digestive, endocrinienne et générale, CHU de Limoges, Limoges, France
- Department of Visceral Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
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10
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Al-Lawati AI, Al Shaibi M, Al Mahruqi G, Augustine T, Moinuddin Z, Al Hinai M, Al Moqbali R, Al Qadhi H. Encapsulating Peritoneal Sclerosis: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e925341. [PMID: 33011732 PMCID: PMC7545366 DOI: 10.12659/ajcr.925341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Encapsulating peritoneal sclerosis (EPS) is a rare, life-threatening, and serious complication of long-term peritoneal dialysis (PD). No evidence-based management strategy has been established until now. Surgical management, including enterolysis and excision of the sclerotic and obstructing adhesions, should be considered as soon as conservative management fails to work. We report a case of EPS soon after transplantation in a patient with end-stage kidney disease who had been on long-term PD. CASE REPORT A 26-year-old man had been found to have advanced chronic kidney disease secondary to glomerulonephritis on pre-employment investigation. He was on continuous ambulatory PD for 5 years, after which he underwent a living donor renal transplant from his full HLA-matched sibling. He did well postoperatively, with excellent graft function. One month after transplantation, he repeatedly presented to our Emergency Department with signs and symptoms of complete small-bowel obstruction. Computed tomography of the abdomen showed features of small-bowel obstruction secondary to interloop adhesions. The patient was initially managed conservatively; however, as his condition continued to deteriorate, an exploratory laparotomy was carried out. Operative findings were suggestive of early EPS localized to the terminal ileum. Total enterolysis along with peritonectomy was performed along with resection of the diseased and obstructing terminal ileum. The patient did well, and he was discharged home day 10 postoperatively. CONCLUSIONS EPS remains a serious and fatal complication of long-term PD. Early definitive diagnosis, treatment, and ultimately surgical intervention may be required to prevent the morbidity and mortality associated with this condition.
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Affiliation(s)
- Ali I Al-Lawati
- Department of Nephrology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Maha Al Shaibi
- Department of Surgical Oncology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ghaitha Al Mahruqi
- Department of General Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Titus Augustine
- Department of Renal and Pancreas Transplantation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Zia Moinuddin
- Department of Renal and Pancreas Transplantation, Central Manchester University Hospitals NHS Foundation Trust, Manchester , United Kingdom
| | - Meerah Al Hinai
- Department of General Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Rana Al Moqbali
- Department of General Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hani Al Qadhi
- Department of General Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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Elyasinia F, Soroush A, Sadeghian E, Taghizadeh N, Mahdavidoust M, Parsaei R, Bagheri MJ. A Rare Cause of Bowel Obstruction. Middle East J Dig Dis 2020; 12:133-135. [PMID: 32626569 PMCID: PMC7320988 DOI: 10.34172/mejdd.2020.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Fezzeh Elyasinia
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Soroush
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Sadeghian
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Taghizadeh
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Mahdavidoust
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Parsaei
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Bagheri
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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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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14
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The use of computed tomography in the diagnosis of abdominal cocoon. Clin Imaging 2018; 50:171-174. [PMID: 29602067 DOI: 10.1016/j.clinimag.2018.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/13/2018] [Accepted: 03/19/2018] [Indexed: 12/27/2022]
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