1
|
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 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.
Collapse
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.
| |
Collapse
|
2
|
Pal NL, Panandiker SD, Katiyar G, Vernekar JA. Unusual causes of Small bowel obstruction: a review of the literature and revisited cross-sectional imaging checklist. Emerg Radiol 2024:10.1007/s10140-024-02256-8. [PMID: 38926239 DOI: 10.1007/s10140-024-02256-8] [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: 05/11/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
Intestinal obstruction is a common surgical emergency with high morbidity and mortality. Patients presenting with features of small bowel obstruction need urgent evaluation to avoid complications such as bowel gangrene, perforation, or peritonitis. Imaging is necessary in most cases of suspected bowel obstruction, to take an appropriate decision, for apt patient management. Among the common causes of small bowel obstruction, adhesions, external herniae, malignancies, and Crohn's disease top the chart. Imaging helps in determining the presence of obstruction, the severity of obstruction, transition point, cause of obstruction, and associated complications such as strangulation, bowel gangrene, and peritonitis. This review is based on the cases with unusual causes of bowel obstruction encountered during our routine practice and also on the extensive literature search through the standard textbooks and electronic databases. Through this review we want our readers to have sound knowledge of the imaging characteristics of the uncommon yet important causes of bowel obstruction. We have also revisited and structured a checklist to simplify the approach while reporting a suspected case of small bowel obstruction. Imaging plays a key role in the diagnosis of small bowel obstruction and in determining the cause and associated complications. Apart from the common causes of small bowel obstruction, we should also be aware of the uncommon causes of small bowel obstruction and their imaging characteristics to make an accurate diagnosis and for apt patient management.
Collapse
Affiliation(s)
- Nilkanth L Pal
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India.
| | - Swamini D Panandiker
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India
| | - Glory Katiyar
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India
| | - Jeevan A Vernekar
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Luna León LG, Vargas Flores J, Carbajal Cabrera PR, Morales Tercero YA, Narvaez Gonzalez HF. Chronic Encapsulated Sclerosing Peritonitis: A Case Report. Cureus 2024; 16:e58003. [PMID: 38738064 PMCID: PMC11087664 DOI: 10.7759/cureus.58003] [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: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
Chronic encapsulated sclerosing peritonitis (CESP) is a very rare cause of intestinal obstruction that has been associated with certain chronic conditions. It is characterized by the thickening of the peritoneum, generating a membrane that covers the intestinal loops and prevents their adequate mobilization. Most cases present as a surgical emergency, leading to a diagnosis during surgery; however, imaging studies can support the pre-surgical diagnosis. Treatment is based on the clinical context of the patient, based on medical management with corticosteroids in a stable patient, or surgical management when it presents as an acute complication. The morbidity and mortality associated with this condition are high and epidemiological data are scarce. There is still a lack of studies to describe the associated demographic data, diagnosis, and treatment.
Collapse
Affiliation(s)
| | - Julian Vargas Flores
- Surgery, Hospital Regional "General Ignacio Zaragoza", ISSSTE, Ciudad de México, MEX
| | | | | | | |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Li F, Xie M. Abdominal cocoon syndrome (ACS): a case report of a Chinese male diagnosed idiopathic ACS with inborn short intestine. Ann Med Surg (Lond) 2024; 86:1152-1155. [PMID: 38333290 PMCID: PMC10849369 DOI: 10.1097/ms9.0000000000001639] [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: 09/12/2023] [Accepted: 12/10/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance Abdominal cocoon syndrome (ACS), as a rare cause of mechanical intestinal obstruction, can be divided into primary/idiopathic vs. secondary type. The primary ACS is often asymptomatic and only diagnosed in exploratory laparotomy. The major treatment of surgery can be challenging. Since the gut wall and peritoneum are densely adhered, gut perforation might occur during adhesiolysis. Thus, it is important to have an experienced surgeon to perform the surgery. Case presentation The authors present a primary ACS case of a 50-year-old man. The patient demonstrated an unbearable upper abdominal pain upon admission. A computed tomography (CT) scan showed a severe bowel obstruction. An exploratory laparotomy was indicated, leading to the diagnosis of ACS, which was considered idiopathic after ruling out secondary factors. An adhesiolysis was performed successfully. Note that the entire intestine measured was only 2.1 m during the surgery. There was no post-surgical complication. The patient was recovered uneventfully. Clinical discussion The aetiology of primary ACS is unknown. The incidence is comparatively low and considered equal between men and women. As a rare cause of gut obstruction, the suspicion of the diagnosis should be strengthened. Surgery including adhesiolysis and bowel resection remains the major treatment. If adhesiolysis fails, bowel resection will be inevitable. The knowledge and experience of surgeon will be tested. Conclusion The aetiology of primary ACS should be further explored. And the differential diagnosis of bowel obstruction should cover ACS in order for the surgeon to be prepared before surgery.
Collapse
Affiliation(s)
- Fei Li
- Departments of Gastrointestinal Surgery
- Hepatobiliary and Pancreatic Surgery, PUREN Hospital Affiliated to WUHAN University of Science and Technology, Wuhan, China
| | - Miao Xie
- Departments of Gastrointestinal Surgery
| |
Collapse
|
7
|
Almouwalld MN. An Idiopathic Case of Sclerosing Encapsulating Peritonitis: A Case Report. Cureus 2024; 16:e53667. [PMID: 38455835 PMCID: PMC10918053 DOI: 10.7759/cureus.53667] [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: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
Sclerosing encapsulating peritonitis, also known as abdominal cocoon syndrome, is an uncommon disorder where a dense fibrous layer forms around the small intestine, causing blockage and vague abdominal complaints. Despite its infrequency, diagnosing and treating this condition is challenging due to its indistinct symptoms and the complex nature of its treatment. This report discusses a 55-year-old female with no notable medical history who experienced progressive abdominal pain and weight loss. Initial laboratory tests revealed mild normocytic anemia and raised levels of inflammatory markers. A computed tomography (CT) scan demonstrated "cocoon-like" encapsulation of the small intestines. After ruling out infectious, neoplastic, and autoimmune factors, the patient was diagnosed with idiopathic sclerosing encapsulating peritonitis. The treatment strategy began with conservative measures, including total parenteral nutrition and antibiotics, but eventually required surgical intervention due to ongoing symptoms. Postoperatively, the patient recovered well, showing significant symptom relief and weight gain at a six-month checkup. This case emphasizes the need to consider sclerosing encapsulating peritonitis when diagnosing unexplained abdominal symptoms, especially when no typical risk factors are present.
Collapse
|
8
|
Daraghmeh L, Eleiwi M, Qamhia N, Maqboul I. Mechanical Bowel Obstruction Due to Secondary Sclerosing Peritonitis, Managed Conservatively: A Case Report. Cureus 2024; 16:e51683. [PMID: 38313947 PMCID: PMC10838387 DOI: 10.7759/cureus.51683] [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: 01/05/2024] [Indexed: 02/06/2024] Open
Abstract
An uncommon cause of intestinal obstruction is an abdominal cocoon, also known as sclerosing encapsulating peritonitis (SEP). We present the case of a 24-year-old female peritoneal dialysis patient who presented with a picture of complete intestinal obstruction. After reviewing the patient's medical history and acquiring relevant laboratory and imaging data, the decision was made to proceed with surgery. Intraoperatively, however, she had a picture of sclerosing peritonitis. The decision was to terminate the surgery and to take a conservative approach, including total parenteral nutrition. Her condition improved, obstruction was resolved, and she was discharged home in good clinical condition. Sclerosing peritonitis should be considered a possible etiology that can be managed conservatively in any peritoneal dialysis patient with intestinal obstruction.
Collapse
Affiliation(s)
- Laith Daraghmeh
- General Surgery, An-Najah National University Hospital, Nablus, PSE
| | - Malak Eleiwi
- Medicine, An-Najah National University Hospital, Nablus, PSE
| | - Naim Qamhia
- Pathology, An-Najah National University Hospital, Nablus, PSE
| | - Iyad Maqboul
- General Surgery, An-Najah National University Hospital, Nablus, PSE
| |
Collapse
|
9
|
Mishra S, Chaudhary K, Tyagi S, Mishra P, Misra V. Primary sclerosing encapsulating peritonitis. INDIAN J PATHOL MICR 2024; 67:182-184. [PMID: 38358217 DOI: 10.4103/ijpm.ijpm_1228_21] [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: 02/16/2024] Open
Abstract
Sclerosing encapsulating peritonitis also known as cocoon abdomen is a rare chronic inflammatory condition of the peritoneum in which the bowel loops are encircled by a membrane (cocoon formation) within the peritoneal cavity leading to intestinal obstruction. It can be primary (idiopathic) or secondary (chemotherapy, beta-blockers, peritoneal dialysis, shunts, tuberculosis, systemic lupus erythematosus, etc.). The symptomatology report includes recurrent episodes of abdominal pain and vomiting. We present here a case of a 32-year-old male who presented with complaints of being unable to pass stools, vomiting (3-4 times), and abdomen pain for 4 days. This case is considered worth mentioning due to its rarity, lack of identification of secondary causes, and diminutive mention of histopathological aspect.
Collapse
Affiliation(s)
- Swati Mishra
- Department of Pathology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Kuldeep Chaudhary
- Department of Pathology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Swati Tyagi
- Department of Pathology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Pratibha Mishra
- Department of Surgery, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Vatsala Misra
- Department of Pathology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| |
Collapse
|
10
|
Rahali A, Aboulfath EM, Njoumi N, Rebbani M, El Brahmi Y, Elfahssi M, Elhjouji A, Zentar A, Ait Ali A. Sclerosing Encapsulating Peritonitis: Solving the Diagnosis Challenge of a Rare Entity. Case Rep Surg 2023; 2023:4022487. [PMID: 38179155 PMCID: PMC10764648 DOI: 10.1155/2023/4022487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 12/10/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is an unusual fibroinflammatory disease of the peritoneum marked by the development of a fibrous membrane enveloping generally the small intestines. The knowledge around this subject is not completely understood. And the etiology can be either idiopathic or secondary to several diseases, treatments, and/or medications. We present a case of a 52-year-old man suffering from atypical clinical symptoms including recurrent abdominal ascites and intestinal obstruction. An abdominal computed tomography showed findings typical of SEP. Therefore, the patient benefited from exploratory laparotomy, which confirmed the diagnosis of idiopathic SEP. Postoperatively, he again had an episode of bowel obstruction, but this was controlled with steroids. Diagnosis of SEP is a real challenge to surgeons, gastroenterologists, and radiologists. And imagery is very helpful to make the diagnosis. Consequently, it is imperative that all hospital practitioners should distinguish between this lesion and other etiology of acute peritonitis.
Collapse
Affiliation(s)
- Anwar Rahali
- Department of Visceral Surgery, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - El Mehdi Aboulfath
- Department of Visceral Surgery, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Noureddine Njoumi
- Department of Visceral Surgery, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Mohammed Rebbani
- Department of Visceral Surgery, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Yasser El Brahmi
- Department of Visceral Surgery, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Mohammed Elfahssi
- Department of Visceral Surgery, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Abderrahman Elhjouji
- Department of Visceral Surgery, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Aziz Zentar
- Department of Visceral Surgery, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Abdelmounaim Ait Ali
- Department of Visceral Surgery, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy, Rabat, Morocco
| |
Collapse
|
11
|
Miyagishima D, Nakagawa A, Mizumachi R. Abdominal Cocoon. Intern Med 2023; 62:3713-3714. [PMID: 37062740 PMCID: PMC10781558 DOI: 10.2169/internalmedicine.1743-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/02/2023] [Indexed: 04/18/2023] Open
Affiliation(s)
| | - Akihiko Nakagawa
- Department of Gastroenterology and Hepatology, Numazu City Hospital, Japan
| | | |
Collapse
|
12
|
Nam SJ, Song SH, Lee SH, Jeung SY, Ah JG, Lee SH, Ryu MO. Peritoneal carcinomatosis with desmoplasia and osseous metaplasia mimicking encapsulating peritoneal sclerosis in a cat: case report. Front Vet Sci 2023; 10:1298736. [PMID: 38105775 PMCID: PMC10722156 DOI: 10.3389/fvets.2023.1298736] [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: 09/22/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023] Open
Abstract
A 13-year-old neutered male Korean short-hair cat presented with anorexia, lethargy, and a severely distended abdomen, suggestive of ascites. Abdominocentesis yielded serosanguineous fluid. A subsequent diagnostic workup, including blood tests, ascitic fluid analysis, imaging studies [radiography, ultrasound, and computed tomography (CT)], and histopathological examination, was performed to identify the underlying cause. Imaging studies revealed characteristics of encapsulating peritoneal sclerosis (EPS) such as peritoneal thickening, fat stranding, and calcification. During laparotomy, fibrous membranes encapsulating the abdominal organs and ascites were observed, and multiple calcified regions were detected on the abdominal wall. Histopathological analysis confirmed the diagnosis of poorly differentiated invasive malignant neoplasms, which were further classified as carcinomatosis based on positive cytokeratin and negative vimentin immunohistochemistry results. To our knowledge, this is the first report of sclerosing peritoneal carcinomatosis with osseous metaplasia in a cat.
Collapse
Affiliation(s)
- So-Jeong Nam
- VIP Animal Medical Center KR, Seoul, Republic of Korea
| | - Sun-Hye Song
- VIP Animal Medical Center KR, Seoul, Republic of Korea
| | | | | | - Jae Gon Ah
- VIP Animal Medical Center KR, Seoul, Republic of Korea
| | - Su-Hyung Lee
- Section of Surgical Sciences, Epithelial Biology Center, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Min-Ok Ryu
- Laboratory of Internal Medicine, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Braet H, Fransen PP, Chen Y, Van Herck S, Mariën R, Vanhoorne V, Ceelen W, Madder A, Ballet S, Hoogenboom R, De Geest B, Hoorens A, Dankers PYW, De Smedt SC, Remaut K. Smart hydrogels delivered by high pressure aerosolization can prevent peritoneal adhesions. J Control Release 2023; 362:138-150. [PMID: 37619864 DOI: 10.1016/j.jconrel.2023.08.042] [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: 02/22/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023]
Abstract
Postoperative peritoneal adhesions occur in the majority of patients undergoing intra-abdominal surgery and are one of the leading causes of hospital re-admission. There is an unmet clinical need for effective anti-adhesive biomaterials, which can be applied evenly across the damaged tissues. We examined three different responsive hydrogel types, i.e. a thermosensitive PLGA-PEG-PLGA, a pH responsive UPy-PEG and a shear-thinning hexapeptide for this purpose. More specifically, their potential to be homogeneously distributed in the peritoneal cavity by high pressure nebulization and prevent peritoneal adhesions was evaluated. Solutions of each polymer type could be successfully nebulized while retaining their responsive gelation behavior in vitro and in vivo. Furthermore, none of the polymers caused in vitro toxicity on SKOV3-IP2 cells. Following intraperitoneal administration, both the PLGA-PEG-PLGA and the hexapeptide hydrogels resulted in local inflammation and fibrosis and failed in preventing peritoneal adhesions 7 days after adhesion induction. In contrast, the pH sensitive UPy-PEG formulation was well tolerated and could significantly reduce the formation of peritoneal adhesions, even outperforming the commercially available Hyalobarrier® as positive control. To conclude, local nebulization of the bioresponsive UPy-PEG hydrogel can be considered as a promising approach to prevent postsurgical peritoneal adhesions.
Collapse
Affiliation(s)
- Helena Braet
- Department of Pharmaceutics, Ghent University, Ghent, Belgium; CRIG - Cancer Research Institute Ghent, Ghent, Belgium
| | | | - Yong Chen
- Department of Pharmaceutics, Ghent University, Ghent, Belgium; CRIG - Cancer Research Institute Ghent, Ghent, Belgium
| | - Simon Van Herck
- Department of Pharmaceutics, Ghent University, Ghent, Belgium; CRIG - Cancer Research Institute Ghent, Ghent, Belgium
| | - Remco Mariën
- Department of Pharmaceutics, Ghent University, Ghent, Belgium
| | | | - Wim Ceelen
- CRIG - Cancer Research Institute Ghent, Ghent, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Annemieke Madder
- CRIG - Cancer Research Institute Ghent, Ghent, Belgium; Department of Organic and Macromolecular Chemistry, Ghent University, Ghent, Belgium
| | - Steven Ballet
- Departments of Chemistry and Bioengineering Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Richard Hoogenboom
- CRIG - Cancer Research Institute Ghent, Ghent, Belgium; Department of Organic and Macromolecular Chemistry, Ghent University, Ghent, Belgium
| | - Bruno De Geest
- Department of Pharmaceutics, Ghent University, Ghent, Belgium; CRIG - Cancer Research Institute Ghent, Ghent, Belgium
| | - Anne Hoorens
- CRIG - Cancer Research Institute Ghent, Ghent, Belgium; Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Patricia Y W Dankers
- Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Stefaan C De Smedt
- Department of Pharmaceutics, Ghent University, Ghent, Belgium; CRIG - Cancer Research Institute Ghent, Ghent, Belgium
| | - Katrien Remaut
- Department of Pharmaceutics, Ghent University, Ghent, Belgium; CRIG - Cancer Research Institute Ghent, Ghent, Belgium.
| |
Collapse
|
15
|
Hasnaoui A, Trigui R, Heni S, Ramdass PVAK. Abdominal cocoon: A rare case report of a small bowel obstruction. Int J Surg Case Rep 2023; 111:108897. [PMID: 37793231 PMCID: PMC10551648 DOI: 10.1016/j.ijscr.2023.108897] [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: 09/14/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Sclerosing encapsulating peritonitis (SEP), or abdominal cocoon, is a remarkably rare entity. It consists of a fibrous layer or cocoon-like sac encasing, in most cases, the small bowel. The lack of specific symptoms makes preoperative diagnosis challenging. CASE PRESENTATION A 50-year-old patient, with no history of abdominal surgery or medical diseases, was admitted for symptoms of small bowel obstruction. On examination, the patient was underweight with a BMI of 18 kg/m2. Vital signs were stable. His abdomen was mildly distended and soft. Abdominal CT scan showed signs in favor of a left paraduodenal hernia with incarcerated small bowel loops. Intraoperatively, the small bowels were encapsulated in a cocoon-like structure formed by thick fibrous tissue associated with multiple adhesions. Careful adhesiolysis with complete resection of the membrane was performed. The postoperative course was uneventful. One year later, the patient was symptom-free. DISCUSSION SEP is thought to be a persistent inflammatory disorder due to a cause that remains unidentified. It is divided into two categories based on its etiology: primary and secondary. The most common mode of SEP revelation is bowel obstruction. Because there is no clear consensus on SEP management, the therapeutic approach typically follows the management strategy of bowel obstruction. CONCLUSION SEP is an uncommon cause of bowel obstruction. Preoperative detection can be challenging in the absence of pathognomonic signs. Treatment is based on surgery, specifically entailing complete excision of the cocoon and adhesiolysis.
Collapse
Affiliation(s)
- Anis Hasnaoui
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia.
| | - Racem Trigui
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Sihem Heni
- Faculty of Medicine of Tunis, Tunis El Manar University, Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebal Lakhdar, 1006 Tunis, Tunisia
| | - Prakash V A K Ramdass
- St. George's University School of Medicine, Department of Public Health and Preventive Medicine, St. George, Grenada
| |
Collapse
|
16
|
Tanriover C, Copur S, Basile C, Ucku D, Kanbay M. Dialysis after kidney transplant failure: how to deal with this daunting task? J Nephrol 2023; 36:1777-1787. [PMID: 37676635 DOI: 10.1007/s40620-023-01758-x] [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] [Received: 12/06/2022] [Accepted: 08/06/2023] [Indexed: 09/08/2023]
Abstract
The best treatment for patients with end-stage kidney disease is kidney transplantation, which, if successful provides both a reduction in mortality and a better quality of life compared to dialysis. Although there has been significant improvement in short-term outcomes after kidney transplantation, long-term graft survival still remains insufficient. As a result, there has been an increase in the number of individuals who need dialysis again after kidney transplant failure, and increasingly contribute to kidney transplant waiting lists. Starting dialysis after graft failure is a difficult task not only for the patients, but also for the nephrologists and the care team. Furthermore, recommendations for management of dialysis after kidney graft loss are lacking. Aim of this narrative review is to provide a perspective on the role of dialysis in the management of patients with failed kidney allograft. Although numerous studies have reported higher mortality in patients undergoing dialysis following kidney allograft failure, reports are contrasting. A patient-centered, individualized approach should drive the choices of initiating dialysis, dialysis modality, maintenance of immunosuppressive drugs and vascular access.
Collapse
Affiliation(s)
- Cem Tanriover
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Via Battisti 192, 74121, Taranto, Italy.
| | - Duygu Ucku
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| |
Collapse
|
17
|
Skarmoutsou AAM, Pujante Antonatou A, Zekeridis T, Fiska A. Idiopathic Sclerosing Encapsulating Peritonitis Associated With Persistent Descending Mesocolon: A Surgical Puzzle. Cureus 2023; 15:e45679. [PMID: 37868492 PMCID: PMC10590021 DOI: 10.7759/cureus.45679] [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: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
During our practice as clinical surgeons, we have encountered situations in which exploratory abdominal laparotomies have yielded unexpected outcomes, despite conducting thorough and rigorous preoperative studies. A rare condition called sclerosing encapsulating peritonitis (SEP), in which a fibrocollagenous membrane encircles the intestine and other abdominal organs, surprised us in a case of an acute abdomen. Persistent descending mesocolon is another unusual condition in which the descending colon is transferred downward and to the right abdominal region because its mesocolon is unable to merge with the posterior abdominal wall. Those two different conditions are extremely rare and were never been described in a single case. We present a case of an 80-year-old male who presented in the emergency department with an acute abdomen and puzzled us.
Collapse
Affiliation(s)
| | | | | | - Aliki Fiska
- Laboratory of Anatomy, Faculty of Medicine, Democritus University of Thrace, Alexandroupoli, GRC
| |
Collapse
|
18
|
Pintar T, Tavčar M, Šušteršič A, Volavšek M. Primary sclerosing encapsulating peritonitis: a case report. J Med Case Rep 2023; 17:318. [PMID: 37443141 DOI: 10.1186/s13256-023-04020-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/02/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Sclerosing encapsulating peritonitis is a rare condition with a typical macroscopic appearance, with fibrocollagenous membrane enclosing loops of the small intestine, causing intestinal obstruction. Unexplained recurrent abdominal pain, obstruction, and a large array of other possible clinical signs and symptoms make sclerosing encapsulating peritonitis a diagnostic challenge. CASE PRESENTATION A 48-year-old man of Persian ethnicity was admitted multiple times to the emergency surgery department due to recurrent sudden abdominal pain and chronic obstruction without significant findings in medical history or clinical evaluation. Computed tomography was positive for proximal jejunal dilatation and duodenojejunal flexure stenosis due to internal mesenteric hernia. Exploratory laparoscopy, followed by laparotomy, confirmed thick membrane-like fibrous tissue with complete small intestinal loop envelopment. Extensive membrane excision and adhesiolysis was performed, but no mesenteric herniation was found. Early postoperative paralytic ileus with introduction of low-dose steroid therapy, based on histopathological and immunological results, confirming type III sclerosing encapsulating peritonitis, was completely resolved. CONCLUSION Sclerosing encapsulating peritonitis is a rare and difficult-to-diagnose condition, further divided into primary and secondary sclerosing encapsulating peritonitis, on the basis of underlying etiology, dictating treatment modality and prognosis. Intraoperative diagnosis and surgical treatment are mandatory, besides a wide variety of abdominal computed tomography scans, inconclusive results, and clinical presentations. There are so far no known specific markers for the diagnosis of sclerosing encapsulating peritonitis.
Collapse
Affiliation(s)
- T Pintar
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
- University Medical Center Ljubljana, Ljubljana, Slovenia.
| | - M Tavčar
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - A Šušteršič
- University Medical Center Ljubljana, Ljubljana, Slovenia
| | - M Volavšek
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
19
|
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.
Collapse
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
| | | | | |
Collapse
|
20
|
Kiniger C, Janssen JN, Lederer KA, Lipnik K, Doulidis PG. Sclerosing encapsulating peritonitis in cats: a two-case report and literature review. JFMS Open Rep 2023; 9:20551169231178447. [PMID: 37434990 PMCID: PMC10331345 DOI: 10.1177/20551169231178447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Case series summary Two castrated male domestic shorthair cats (aged 8 months [case 1] and 13 years [case 2]) were presented at the Small Animal Clinic of the Veterinary Medicine University of Vienna, Austria, both with acute vomiting and distended abdomen, as well as a history of chronic apathy, recurrent vomiting and diarrhoea. Both cats underwent invasive diagnostic procedures approximately 1 month before the diagnosis of sclerosing encapsulating peritonitis (SEP), namely an exploratory laparotomy and a bronchoscopy, respectively. Abdominal ultrasound revealed severely corrugated intestinal loops and, in case 2, the presence of peritoneal effusion. A thick and diffuse fibrous capsule around the intestine was detected and removed surgically, and biopsies were taken from the affected organs confirming the SEP. Case 1 recovered well, was discharged some days after surgery and was clinically unremarkable for the next 2 years. Case 2 showed unsatisfactory improvement directly after surgery and was euthanased a few days later, as the owner declined any further therapy. Relevance and novel information SEP is a very rare condition of unclear origins in cats. Here we describe the clinical and diagnostic imaging features, surgical treatment, and outcome of SEP in two cats. The results indicate that prompt diagnosis and appropriate interventions may improve the outcome.
Collapse
Affiliation(s)
- Caterina Kiniger
- Clinical Unit of Small Animal Internal Medicine, Department for Small Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Janina N Janssen
- Clinical Unit of Small Animal Surgery, Department for Small Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Kristina A Lederer
- Diagnostic Imaging, Department for Small Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Karoline Lipnik
- Institute of Pathology, Department of Pathobiology, University of Veterinary Medicine, Vienna, Austria
| | - Pavlos G Doulidis
- Clinical Unit of Small Animal Internal Medicine, Department for Small Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| |
Collapse
|
21
|
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.
Collapse
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
| | | |
Collapse
|
22
|
McCrory MA, Heard MA, Wright JG, Roche KF. Sclerosing Encapsulating Peritonitis: A Rare Cause of Bowel Obstruction. Am Surg 2023:31348231160821. [PMID: 36872044 DOI: 10.1177/00031348231160821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Sclerosing encapsulating peritonitis (SEP), also referred to as abdominal cocoon syndrome, is a rare cause of bowel obstruction characterized by a thickened fibrous peritoneum that encapsulates the intestines. The exact etiology is idiopathic but may be associated with long-term peritoneal dialysis (PD). In the absence of risk factors for adhesive disease, preoperative diagnosis can be difficult and may require operative intervention or advanced imaging to diagnose. Thus, the inclusion of SEP in the differential diagnosis for bowel obstruction is essential for early detection. Existing literature is focused on renal disease as an origin, but it can be multifactorial. Here, we discuss a case of sclerosing encapsulating peritonitis in a patient without known risk factors.
Collapse
Affiliation(s)
- Mary A McCrory
- Quillen College of Medicine, 12324East Tennessee State University, Johnson City, TN, USA
| | - Matthew A Heard
- Quillen College of Medicine, 12324East Tennessee State University, Johnson City, TN, USA
| | - Jessica G Wright
- Quillen College of Medicine, 12324East Tennessee State University, Johnson City, TN, USA
| | - Keelin F Roche
- Quillen College of Medicine, 12324East Tennessee State University, Johnson City, TN, USA
| |
Collapse
|
23
|
Srisajjakul S, Prapaisilp P, Bangchokdee S. Imaging pearls and differential diagnosis of encapsulating peritoneal sclerosis: Emphasis on computed tomography. Clin Imaging 2023; 94:116-124. [PMID: 36527797 DOI: 10.1016/j.clinimag.2022.12.001] [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: 09/29/2022] [Revised: 11/20/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a severe peritoneal fibrotic reaction most frequently identified as a complication of peritoneal dialysis. EPS is a complex condition whose management requires multidisciplinary input from radiologists, gastroenterologists, nephrologists, surgeons, and dietitians. EPS carries significant morbidity and mortality, primarily due to bowel obstruction that results in intestinal failure, malnutrition, and sepsis. The nondialysis causes of EPS include tuberculous peritonitis, prior abdominal surgery, beta-blocker medication use, and endometriosis. The clinical symptoms of EPS are nausea, vomiting, and abdominal pain, all of which appear to be associated with bowel obstruction. The diagnosis of EPS needs three pillars to be met: clinical features, radiological evaluation, and histopathological analysis. The disease is frequently progressive and can be fatal. Computed tomography is the gold standard imaging modality for the detection of peritoneal abnormalities and encapsulation of bowel loops by thick adhesions or fibrosis (cocooning). Computed tomography also aids in making a differential diagnosis. Unfortunately, the diagnosis of EPS is often delayed because clinical findings are not specific and may resemble other peritoneal diseases. Radiologists should be familiar with the clinical impacts and related imaging features of EPS and realize when to seek them to facilitate timely and proper treatment.
Collapse
Affiliation(s)
- Sitthipong Srisajjakul
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Patcharin Prapaisilp
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | |
Collapse
|
24
|
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.
Collapse
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.
| |
Collapse
|
25
|
Tambuzzi S, Gentile G, Boracchi M, Zoja R, Gentilomo A. A forensic case of abdominal cocoon syndrome. Forensic Sci Med Pathol 2022:10.1007/s12024-022-00562-6. [PMID: 36459388 DOI: 10.1007/s12024-022-00562-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 12/04/2022]
Abstract
The term "cocoon syndrome" defines a sclerosing encapsulating peritonitis (SEP) that involves a chronic fibrotic inflammatory reaction of the parietal peritoneum and of the viscera leading to a complete sclerosis. The cocoon that is formed causes an incarceration of the intestinal loops with severe complications leading to high mortality. We are presenting the case of a 15-year-old young man that underwent surgery for appendectomy and that was evaluated for having a regular abdominal state. During the post-surgery period, however, several episodes of intestinal occlusion required further surgical interventions leading to a right hemicolectomy. The presence of a fibrotic-adhesive ligneous peritonitis with blended intestinal loops, severely thickened walls, and intestinal scaring stenosis was observed during his second surgical operation. A stenosis of the colostomy led to a worsening of the vital signs of the young man with the onset of a cardiac failure and subsequent decease. Macroscopic autopsy examination and histological analysis confirmed the severe obstructive adhesive encapsulating abdominal context allowing to trace back the cause of death to a cocoon syndrome. Since no predisposing factor could be found, we hypothesized that this case could be characterized by an excessive peritoneal reactivity due to surgical appendectomy. Cocoon syndrome is a rare pathology, and its microscopic features are seldomly observed and could be underestimated. We present a directly observed case with a very substantial macroscopic and microscopic context.
Collapse
Affiliation(s)
- Stefano Tambuzzi
- Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute , Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133, Milan, Italy
| | - Guendalina Gentile
- Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute , Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133, Milan, Italy.
| | - Michele Boracchi
- Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute , Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133, Milan, Italy
| | - Riccardo Zoja
- Laboratorio di Istopatologia Forense e Microbiologia Medico Legale, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute , Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133, Milan, Italy
| | - Andrea Gentilomo
- Dipartimento di Scienza Giuridiche "Cesare Beccaria", Università degli Studi di Milano, Via festa del Perdono, 7, 20122, Milan, Italy
| |
Collapse
|
26
|
Samir H, Swelum AA, Kandiel MMM. Editorial: Exploring roles of diagnostic ultrasonography in veterinary medicine. Front Vet Sci 2022; 9:1084676. [PMID: 36467656 PMCID: PMC9716267 DOI: 10.3389/fvets.2022.1084676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/10/2022] [Indexed: 10/14/2023] Open
Affiliation(s)
- Haney Samir
- Department of Theriogenology, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Ayman A. Swelum
- Department of Theriogenology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed M. M. Kandiel
- Department of Theriogenology, Faculty of Veterinary Medicine, Benha University, Toukh, Egypt
| |
Collapse
|
27
|
A Rare Case of Small Bowel Obstruction in a Patient with Endosalpingiosis, Fitz-Hugh-Curtis Syndrome, and Chlamydia trachomatis Pelvic Inflammatory Disease. Case Rep Surg 2022; 2022:2451428. [PMID: 36317048 PMCID: PMC9617720 DOI: 10.1155/2022/2451428] [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: 02/06/2022] [Revised: 08/27/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
A 19-year-old female has multiple presentations to emergency department with recurrent abdominal pain. During her third presentation, the radiological features were suggestive of high-grade small bowel obstruction in a virgin abdomen. A diagnostic laparoscopy has been performed. The intraoperative findings include a band adhesion between omentum and small bowel mesentery, and perihepatic adhesions consistent with Fitz-Hugh-Curtis syndrome. The histopathology from a biopsy of the macular lesions of the abdominal wall showed endosalpingiosis. The postoperative high vaginal swab was positive for Chlamydia trachomatis. The underlying cause of her small bowel obstruction could be due to pelvic inflammatory disease, Fitz-Hugh-Curtis syndrome, or endosalpingiosis. We aimed to create awareness amongst readers that small bowel obstruction in young female patients with no prior abdominal surgery is possible and often difficult to diagnose immediately.
Collapse
|
28
|
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.
Collapse
|
29
|
Mansour M, Alabrach YS, Eladl M, Attia KE, El Nogoomi I. Sclerosing Encapsulating Peritonitis Mimicking an Internal Hernia: A Case Report. Cureus 2022; 14:e28476. [PMID: 36176872 PMCID: PMC9512256 DOI: 10.7759/cureus.28476] [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] [Accepted: 08/27/2022] [Indexed: 11/12/2022] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare entity that could lead to abdominal obstruction; however, despite being reported in several case series, its underlying pathophysiology is still unclear. A large proportion of SEP cases are diagnosed incidentally or after surgical exploration, which poses a great challenge to pre-operative diagnosis. We hereby report a case of a 33-year-old male patient who presented with cachexia and a clinical picture of complete small bowel obstruction. CT scan of the abdomen raised suspicion of an internal hernia, prompting explorative surgical evaluation. Laparoscopy showed encasement of the small bowel loops in a thick fibrocollagenous membrane characteristic of SEP. Laparotomy with adhesiolysis and membrane excision successfully led to the resolution of obstruction. Retrospective interpretation of the initial CT scan confirmed the presence of SEP’s characteristic radiological signs and provided an insight into how it contrasts with an internal hernia. This case provides an opportunity to highlight the differences between the two clinical entities and the pre-operative diagnostic strategies.
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
Gremillet BCH, Porsmoguer C, Bolen G, Billen F, Noël S, Brutinel F, Busoni V. Imaging Findings in Dogs and Cats With Presumptive Sclerosing Encapsulating Peritonitis. Front Vet Sci 2022; 9:891492. [PMID: 35754547 PMCID: PMC9218854 DOI: 10.3389/fvets.2022.891492] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
This retrospective case series describes imaging findings in seven dogs and two cats with a presumptive diagnosis of sclerosing encapsulating peritonitis (SEP) between 2014 and 2021. Peritoneal effusion was present in all animal patients. Sonographically, echogenic fluid with or without echogenic intraperitoneal septations, gathered or corrugated bowel loops, and abdominal lymphadenomegaly were suggesting an inflammatory process and the presence of adhesions. Gathering of the bowel with abdominal distension and/or signs of intestinal obstruction were major findings on radiographs. Abdominal fat stranding was an additional finding in animals undergoing a CT examination. Previous surgery, pregnancy, and the presence of a perforating foreign body were potential predisposing causes in 4/9 animals. Peritonitis was septic in 4/9 animals. As SEP is a rare condition but life threatening, this detailed description of imaging findings in a short case series can be useful for a presumptive diagnosis and surgical planning.
Collapse
Affiliation(s)
- Bérengère C H Gremillet
- Département des Animaux de Compagnie, Clinique Vétérinaire Universitaire, Université de Liège, Liège, Belgium
| | - Charles Porsmoguer
- Département des Animaux de Compagnie, Clinique Vétérinaire Universitaire, Université de Liège, Liège, Belgium
| | - Géraldine Bolen
- Département des Animaux de Compagnie, Clinique Vétérinaire Universitaire, Université de Liège, Liège, Belgium
| | - Frédéric Billen
- Département des Animaux de Compagnie, Clinique Vétérinaire Universitaire, Université de Liège, Liège, Belgium
| | - Stéphanie Noël
- Département des Animaux de Compagnie, Clinique Vétérinaire Universitaire, Université de Liège, Liège, Belgium
| | - Flore Brutinel
- Département des Animaux de Compagnie, Clinique Vétérinaire Universitaire, Université de Liège, Liège, Belgium
| | - Valeria Busoni
- Département des Animaux de Compagnie, Clinique Vétérinaire Universitaire, Université de Liège, Liège, Belgium
| |
Collapse
|
32
|
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.
Collapse
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
| |
Collapse
|
33
|
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.
Collapse
|
34
|
Sghair A, Debaibi M, Kchaou M, Talbi S, Sridi A, Chouchen A. Idiopathic sclerosing encapsulating peritonitis: An uncommon cause of intestinal obstruction in a virgin abdomen. Clin Case Rep 2022; 10:e05603. [PMID: 35317068 PMCID: PMC8922953 DOI: 10.1002/ccr3.5603] [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: 12/27/2021] [Revised: 02/15/2022] [Accepted: 03/07/2022] [Indexed: 11/26/2022] Open
Abstract
Idiopathic sclerosing encapsulating peritonitis is a clinical entity characterized by partial or complete encasement of the digestive tract by a fibrous membrane. The preoperative diagnosis is difficult to establish. The diagnosis of sclerosing encapsulating peritonitis should be considered for patients without any surgical history and admitted for intestinal obstruction, especially for patients having peritoneal dialysis. We herein report the case of a 50‐year‐old man with idiopathic encapsulating peritonitis complicated by intestinal obstruction and ischemia. Idiopathic sclerosing encapsulating peritonitis is a rare disease. The diagnosis is made generally during a surgical procedure. Surgery seems to be the best management option for patients with severe signs of intestinal obstruction. Total resection of membrane avoids recurrences but it is associated with higher morbidity and mortality
Collapse
Affiliation(s)
- Asma Sghair
- Departement of general surgery Internal Security Forces Hospital Marsa Tunisia
- Faculty of medicine of Tunis University of Tunis El Manar Marsa Tunisia
| | - Mehdi Debaibi
- Departement of general surgery Internal Security Forces Hospital Marsa Tunisia
- Faculty of medicine of Tunis University of Tunis El Manar Marsa Tunisia
| | - Majdi Kchaou
- Departement of general surgery Internal Security Forces Hospital Marsa Tunisia
- Faculty of medicine of Tunis University of Tunis El Manar Marsa Tunisia
| | - Skander Talbi
- Departement of general surgery Internal Security Forces Hospital Marsa Tunisia
- Faculty of medicine of Tunis University of Tunis El Manar Marsa Tunisia
| | - Azza Sridi
- Departement of general surgery Internal Security Forces Hospital Marsa Tunisia
- Faculty of medicine of Tunis University of Tunis El Manar Marsa Tunisia
| | - Adnen Chouchen
- Departement of general surgery Internal Security Forces Hospital Marsa Tunisia
- Faculty of medicine of Tunis University of Tunis El Manar Marsa Tunisia
| |
Collapse
|
35
|
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.
Collapse
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
| |
Collapse
|
36
|
Chaudhary S, Toro D, Vishnoi V, Sufyan W, Bradbury R. Abdominal cocoon with eosinophilic infiltrate. ANZ J Surg 2021; 92:1506-1507. [PMID: 34726819 DOI: 10.1111/ans.17294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Shreyas Chaudhary
- Royal Darwin Hospital, Department of Surgery, Tiwi, Northern Territory, Australia
| | - David Toro
- Royal Darwin Hospital, Department of Surgery, Tiwi, Northern Territory, Australia
| | - Veral Vishnoi
- Royal Darwin Hospital, Department of Surgery, Tiwi, Northern Territory, Australia
| | - Wajiha Sufyan
- Royal Darwin Hospital, Department of Surgery, Tiwi, Northern Territory, Australia
| | - Richard Bradbury
- Royal Darwin Hospital, Department of Surgery, Tiwi, Northern Territory, Australia
| |
Collapse
|
37
|
Mofti AH, Ghabashi FA, Sadagah MM, Ibrahim MA, Altowairqi AM, Zabidi AH, Farhan MM, Alghamdi NA, Olwi KM, Algethami RO, Khubrani RA, Alkhamsan HM, Almansour MH, Alshammari FA, Alshammari M. Sclerosing Encapsulating Peritonitis Following Recovery From COVID-19 Pneumonia. Cureus 2021; 13:e19306. [PMID: 34900482 PMCID: PMC8649975 DOI: 10.7759/cureus.19306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is primarily a respiratory illness and pulmonary manifestations are the typical presentations of the disease. However, it became evident that the COVID-19 is not limited to the respiratory system. Specifically, gastrointestinal involvement in patients with COVID-19 is very common, particularly in patients with a critical illness. We present a case of a 52-year-old man who was diagnosed as having severe COVID-19 pneumonia and underwent endotracheal intubation and mechanical ventilation. The patient remained in the intensive care unit for seven days. Following his recovery, he started to experience generalized abdominal pain. The pain did not resolve with conservative measures. A computed tomography scan of the abdomen demonstrated small bowel loops clustered with a surrounding thin membrane. Such findings conferred the diagnosis of sclerosing encapsulating peritonitis. The patient was prepared for laparoscopic surgery. Resection of the membrane was performed without any injury to the encapsulated bowel. Analysis of peritoneal fluid by reverse transcription-polymerase chain reaction (RT-PCR) was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The patient had an uneventful recovery. Sclerosing encapsulating peritonitis is a very rare condition associated with COVID-19 pneumonia. The present case is the first reported case to document the presence of the SARS-CoV-2 virus in the peritoneal fluid in a patient with sclerosing encapsulating peritonitis.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Khalid M Olwi
- College of Medicine, University of Jeddah, Jeddah, SAU
| | | | - Reem A Khubrani
- Family Medicine, Al-Khabariah Primary Health Care, Jazan, SAU
| | | | | | - Fahad A Alshammari
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Malak Alshammari
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| |
Collapse
|
38
|
Mohammed F, Abdulkarim M, Ibn Yasir A, Taleballah O, Shani D, Salih N. Abdominal cocoon syndrome, a case report of a rare disease entity causing intestinal obstruction. Int J Surg Case Rep 2021; 87:106401. [PMID: 34534813 PMCID: PMC8449068 DOI: 10.1016/j.ijscr.2021.106401] [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: 08/28/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE 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. Less than 300 cases have been reported from all over the world. This is the first case of such a disease entity to be reported from Sudan. CASE PRESENTATION A young female patient, presented with features of intestinal obstruction that was managed conservatively. Failure of the conservative management has warranted a laparotomy. CLINICAL FINDINGS AND INVESTIGATIONS Her features were suggestive of intestinal obstruction that was confirmed radiologically. INTERVENTIONS AND OUTCOME Laparotomy revealed a membrane-like fibrous material and extensive multiple loops adhesions, findings consistent with primary sclerosing encapsulating peritonitis (PSEP), also known as abdominal cocoon's disease. The membrane was excised and adhesiolysis was done. Intestinal obstruction was relieved after surgery and the patient showed good outcome. CONCLUSIONS Abdominal cocoon syndrome is a rare cause of intestinal obstruction. RELEVANCE AND IMPACT The takeaway lesson from this case would be that the PSEP should be sought in any patient with no clear cause for obstruction can be identified. A contrast-enhanced CT scan is the diagnostic modality of choice. Finally, we think that the disease is underreported from Africa and more efforts should be carried out to increase patients' access to healthcare especially in rural areas with no access to hospitals in order to bring more cases to light. This case report has been reported in line with the SCARE Criteria (Agha et al., 2020 [17]).
Collapse
Affiliation(s)
| | | | | | | | - Dafalla Shani
- Alzaiem Alazhari University - Department of Surgery, Sudan
| | - Nadir Salih
- Alzaiem Alazhari University - Department of Surgery, Sudan
| |
Collapse
|
39
|
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.
Collapse
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
| |
Collapse
|
40
|
Sclerosing Encapsulating Peritonitis in a Pediatric Patient Treated With Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. J Pediatr Hematol Oncol 2021; 43:e685-e688. [PMID: 32769559 DOI: 10.1097/mph.0000000000001899] [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: 01/10/2020] [Accepted: 06/26/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sclerosing encapsulating peritonitis (SEP) is a rare chronic inflammatory condition characterized by small bowel encapsulation by a thick fibrocollagenous membrane. Patients with SEP often present with nonspecific symptoms, such as abdominal pain and distension, however some patients may present with symptoms suggestive of intestinal obstruction. Secondary SEP has been reported in patients undergoing peritoneal dialysis and has been recently described in adults following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). OBSERVATIONS We report a clinical case of a 13-year-old female who presented with worsening abdominal pain and distension and persistent emesis who was found to have SEP 13 months following CRS and HIPEC for management of desmoplastic small round cell tumor and subsequently required operative intervention. CONCLUSION Although there have been published reports of adult patients experiencing cases of SEP following CRS/HIPEC, this is the first published case of secondary SEP occurring in a pediatric oncology patient.
Collapse
|
41
|
Srivastava V, Jha PK, Mangla M, Ansari MA. A massive air-fluid level on abdominal skiagram: an indicator of hollow viscous perforation inside an abdominal cocoon. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02857-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
42
|
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.
Collapse
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
| |
Collapse
|
43
|
Idiopathic Sclerosing Encapsulating Peritonitis in a Patient with Atypical Symptoms and Imaging Findings. Case Rep Gastrointest Med 2021; 2021:6695806. [PMID: 33880193 PMCID: PMC8046571 DOI: 10.1155/2021/6695806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 12/14/2022] Open
Abstract
Sclerosing encapsulating peritonitis is a rare condition caused by a fibrotic membrane covering the small bowel which may lead to abdominal pain or obstruction. The cause may be primary and idiopathic or secondary to several diseases, treatments, and/or medications. The condition typically presents with bowel obstruction, and only one previous case has described ascites as the presenting sign. Sclerosing encapsulating peritonitis is typically diagnosed intraoperatively. We present a case of a patient who presented with atypical clinical symptoms including respiratory distress, recurrent abdominal ascites, and failure to thrive who was diagnosed nonoperatively.
Collapse
|
44
|
Saqib SU, Farooq R, Saleem O, Moeen S, Chawla TU. Acute presentation of cocoon abdomen as septic peritonitis mimicking with strangulated internal herniation: a case report. Surg Case Rep 2021; 7:93. [PMID: 33851284 PMCID: PMC8044279 DOI: 10.1186/s40792-021-01179-7] [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: 11/17/2020] [Accepted: 04/09/2021] [Indexed: 01/01/2023] Open
Abstract
Background Abdominal cocoon syndrome is a rare cause of intestinal obstruction in which loops of small bowel get entrapped inside a fibro-collagenous membrane. Condition is also known in the literature as sclerosing peritonitis and in the majority of cases, it has no known cause. Although the majority of patients exhibit long-standing signs and symptoms of partial bowel obstruction in an out-patient clinic, its acute presentation in the emergency room with features of sepsis is extremely rare. This case report aims to describe the emergency presentation of cocoon abdomen with septic peritonitis. Case presentation A 35-year-old male with no known co-morbidity and no prior history of prior laparotomy presented in emergency room first time with a 1-day history of generalized abdomen pain, vomiting, and absolute constipation. He was in grade III shock and had metabolic acidosis. The clinical impression was of the perforated appendix, but initial contrast-enhanced computed tomography (CECT) was suggestive of strangulated internal herniation of small bowel. Emergency laparotomy after resuscitation revealed hypoperfused, but viable loops of small bowel entrapped in the sclerosing membrane. Extensive adhesiolysis and removal of the membrane were performed and the entire bowel was straightened. Postoperatively he remained well and discharged as planned. Histopathology report confirms features of sclerosing peritonitis. Discussion Cocoon abdomen is a very rare cause of acute small bowel obstruction presenting in an emergency with features of septic peritonitis. Condition is mostly chronic and generally mimics abdominal TB in endemic areas like India and Pakistan. A high index of suspicion is required in an emergency setting and exploratory laparotomy is diagnostic and therapeutic as well and the condition mimics internal herniation in acute cases. Conclusion Cocoon abdomen as a cause of septic peritonitis is extremely rare and might be an unexpected finding at laparotomy. Removal of membrane and estimation of the viability of entrapped bowel loops is the treatment of choice, which may require resection in the extreme case of gangrene.
Collapse
|
45
|
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.
Collapse
|
46
|
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.
Collapse
|
47
|
Leeoloy J, Kambojia M, Wagle Shukla A, Liu X, Shukla A. Encapsulated Peritoneal Sclerosis Masquerading as an Abdominal Catastrophe in Peritoneal Dialysis Therapy. Cureus 2021; 13:e12934. [PMID: 33654614 PMCID: PMC7910223 DOI: 10.7759/cureus.12934] [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] [Indexed: 12/04/2022] Open
Abstract
Encapsulated peritoneal sclerosis (EPS) is a rare but known complication of peritoneal dialysis (PD) therapy in patients with end-stage renal disease (ESRD). It commonly manifests insidiously with recurrent intestinal obstruction and malnutrition, worsening over time. We report an ESRD patient on PD therapy for six years presenting with an acute intestinal obstruction, bowel hernia, bowel ischemia, and hemodynamic instability. CT abdomen revealed thickening of walls of colon and ileum in the right lower quadrant, with signs of small bowel obstruction. Patient underwent emergency laparotomy for the repair of hernia and resection of ischemic bowel, and intraoperatively, was found to have dusky, edematous, thickened, inflamed, and distended distal bowels with adhesions in the right lower quadrant. The pathological examination revealed a thin membrane encasing the ileum, colon and the mesenteric tissue diffusely. Microscopic examination of resected bowel showed marked submucosal edema with myxoid and inflammatory changes. Based on these clinical, radiological and pathological findings, a diagnosis of EPS was established. Her postoperative course was complicated by recurrent intraabdominal bleeding with hemoperitoneum, leading to disseminated intravascular coagulation, multiorgan failure, and death, two weeks after the surgery. EPS can present as an acute abdominal catastrophe. Although there are recommendations for ascertainment of EPS diagnosis, there are no clear guidelines for safe and effective surgical strategies and these warrant further research.
Collapse
Affiliation(s)
- Justin Leeoloy
- Medicine, University of Florida College of Medicine, Gainesville, USA
| | | | | | - Xuili Liu
- Pathology, University of Florida, Gainesville, USA
| | - Ashutosh Shukla
- Medicine/Nephrology, North Florida/South Georgia (NF/SG) Veteran Healthcare System, Gainesville, USA.,Medicine, University of Florida College of Medicine, Gainesville, USA
| |
Collapse
|
48
|
Asotibe JC, Zargar P, Achebe I, Mba B, Kotwal V. Secondary Abdominal Cocoon Syndrome Due To Chronic Beta-Blocker Use. Cureus 2020; 12:e10509. [PMID: 33094050 PMCID: PMC7571602 DOI: 10.7759/cureus.10509] [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] [Indexed: 11/08/2022] Open
Abstract
Sclerosing encapsulating peritonitis (SEP), which is interchangeably used with the term ‘’abdominal cocoon syndrome’’, is a rare condition characterized by a thick fibrous membrane encasing portions of the intestinal wall leading to recurrent bowel obstructions. To date, literature describing the association between this condition and chronic beta-blocker therapy is scarce. This report adds by detailing a rare presentation of SEP and highlights an understudied yet important association of SEP with chronic beta-blocker therapy.
Collapse
Affiliation(s)
| | - Pejman Zargar
- Gastroenterology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Ikechukwu Achebe
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Benjamin Mba
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Vikram Kotwal
- Gastroenterology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| |
Collapse
|
49
|
Sivakumar J, Brown G, Galea L, Choi J. An intraoperative diagnosis of sclerosing encapsulating peritonitis: a case report. J Surg Case Rep 2020; 2020:rjaa329. [PMID: 32934790 PMCID: PMC7480954 DOI: 10.1093/jscr/rjaa329] [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: 07/03/2020] [Accepted: 07/27/2020] [Indexed: 12/23/2022] Open
Abstract
Primary sclerosing encapsulating peritonitis (SEP) is an idiopathic and rare condition characterized by chronic peritoneal inflammation. We describe the case of an intraoperative diagnosis of SEP, presenting as a mimicker of small bowel obstruction. The patient was a 59-year-old male with suspected small bowel obstruction. On exploratory laparotomy, it was noted that there was thick fibrous tissue involving the visceral and parietal peritoneum enveloping grossly dilated loops of small bowel. This case reports on the histopathological features of peritoneal biopsies as well as radiological findings. There is no consensus regarding the standard management for idiopathic SEP. The present case demonstrates a significant improvement in the patient’s condition with conservative management alone. A critical teaching point is that in the absence of an obvious cause, SEP is a rare but important differential diagnosis for surgeons to consider in the context of recurrent bowel obstruction.
Collapse
Affiliation(s)
- Jonathan Sivakumar
- Clinical Institute of General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Victoria, Australia
| | - Gregor Brown
- Clinical Institute of General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Victoria, Australia
| | - Laurence Galea
- Department of Anatomical Pathology, Melbourne Pathology, Melbourne, Victoria, Australia
| | - Julian Choi
- Clinical Institute of General Surgery and Gastroenterology, Epworth Healthcare, Richmond, Victoria, Australia
| |
Collapse
|
50
|
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.
Collapse
Affiliation(s)
- Jeong Ho Kang
- Department of Emergency Medicine, Jeju National University School of Medicine, Jeju-do, Republic of Korea
| |
Collapse
|