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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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Deng P, Xiong LX, He P, Hu JH, Zou QX, Le SL, Wen SL. Surgical timing for primary encapsulating peritoneal sclerosis: A case report and review of literature. World J Gastrointest Surg 2022; 14:352-361. [PMID: 35664367 PMCID: PMC9131833 DOI: 10.4240/wjgs.v14.i4.352] [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: 11/28/2021] [Revised: 01/06/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary encapsulating peritoneal sclerosis (EPS) is a rare but devastating disease that causes fibrocollagenous cocoon-like encapsulation of the bowel, resulting in bowel obstruction. The pathogenesis, prevention, and treatment strategies of EPS remain unclear so far. Since most patients are diagnosed during exploratory laparotomy, for the non-surgically diagnosed patients with primary EPS, the surgical timing is also uncertain. CASE SUMMARY A 44-year-old female patient was referred to our center on September 6, 2021, with complaints of abdominal distention and bilious vomiting for 2 d. Physical examination revealed that the vital signs were stable, and the abdomen was slightly distended. Computerized tomography scan showed a conglomerate of multiple intestinal loops encapsulated in a thick sac-like membrane, which was surrounded by abdominal ascites. The patient was diagnosed with idiopathic EPS. Recovery was observed after abdominal paracentesis, and the patient was discharged on September 13 after the resumption of a normal diet. This case raised a question: When should an exploratory laparotomy be performed on patients who are non-surgically diagnosed with EPS. As a result, we conducted a review of the literature on the clinical manifestations, intraoperative findings, surgical methods, and therapeutic effects of EPS. CONCLUSION Recurrent intestinal obstructions and abdominal mass combined with the imaging of encapsulated bowel are helpful in diagnosing idiopathic EPS. Small intestinal resection should be avoided.
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Affiliation(s)
- Peng Deng
- Department of General Surgery, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
| | - Long-Xin Xiong
- Department of General Surgery, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
| | - Ping He
- Department of General Surgery, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
| | - Jian-Hua Hu
- Department of Emergency Surgery, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
| | - Qi-Xu Zou
- Department of General Surgery, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
| | - Shi-Lian Le
- Department of General Surgery, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
| | - Sen-Lin Wen
- Department of General Surgery, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
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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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Dalla Pria HR, Torres US, Velloni F, Santiago RA, Zacarias MS, Silva LF, Tamamoto F, Walsh D, von Atzingen AC, Coffey JC, D'Ippolito G. The Mesenteric Organ: New Anatomical Concepts and an Imaging-based Review on Its Diseases. Semin Ultrasound CT MR 2019; 40:515-532. [DOI: 10.1053/j.sult.2019.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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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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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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