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Li A, Li L, Guo F, Zhou D, Yang W, Cui W, Wu S, Li L, Yu C, Lin H. The role of computed tomography in the diagnosis of encapsulating peritoneal sclerosis in patients undergoing peritoneal dialysis. Ren Fail 2024; 46:2312214. [PMID: 38344999 PMCID: PMC10863510 DOI: 10.1080/0886022x.2024.2312214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024] Open
Affiliation(s)
- Aomei Li
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Longkai Li
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fujia Guo
- First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Dan Zhou
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wei Yang
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wengting Cui
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuran Wu
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lin Li
- Medical Innovation Research Division of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Changqing Yu
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hongli Lin
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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Harada W, Banshodani M, Shimamoto F, Shintaku S, Moriishi M, Masaki T, Kawanishi H. Encapsulating Peritoneal Sclerosis 43 Years after Distal Gastrectomy for Early Gastric Cancer. Intern Med 2024; 63:659-663. [PMID: 37468244 PMCID: PMC10982008 DOI: 10.2169/internalmedicine.2037-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/11/2023] [Indexed: 07/21/2023] Open
Abstract
We herein report a case of encapsulating peritoneal sclerosis (EPS) in a patient without chronic kidney disease after gastrectomy. A 69-year-old man underwent distal gastrectomy for early gastric cancer at 25 years old. After 43 years, he developed bowel obstruction and underwent enterolysis of the encapsulated small intestine. A pathological examination of the capsular membranes revealed inflammation, foam, and giant cells that destroyed foreign substances. The patient was discharged 1.5 months later. Foreign body reactions to surgical instruments used in gastrectomy are considered a cause of EPS. EPS due to foreign body reactions to surgical instruments should also be considered in such cases.
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Affiliation(s)
- Wataru Harada
- Department of Kidney Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Japan
- Department of Nephrology, Hiroshima University Hospital, Japan
| | - Masataka Banshodani
- Department of Kidney Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Japan
| | - Fumio Shimamoto
- Diagnostic Pathology, Pathology Clinic, Japan
- Department of Nursing, Faculty of Health Sciences Dean, Hiroshima Cosmopolitan University, Japan
| | - Sadanori Shintaku
- Department of Kidney Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Japan
| | - Misaki Moriishi
- Department of Kidney Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, Japan
| | - Hideki Kawanishi
- Department of Kidney Disease and Blood Purification Therapy, Akane-Foundation, Tsuchiya General Hospital, Japan
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3
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Wang CJ, Chao YJ, Liu YS, Liao FT, Chang SS, Liao TK, Lu WH, Su PJ, Shan YS. Prediction of surgical outcomes in severe encapsulating peritoneal sclerosis using a computed tomography scoring system. J Formos Med Assoc 2024; 123:98-105. [PMID: 37365098 DOI: 10.1016/j.jfma.2023.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 04/27/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND/PURPOSE Encapsulating peritoneal sclerosis (EPS) is a rare and potential lethal complication of peritoneal dialysis characterized by bowel obstruction. Surgical enterolysis is the only curative therapy. Currently, there are no tools for predicting postsurgical prognosis. This study aimed to identify a computed tomography (CT) scoring system that could predict mortality after surgery in patients with severe EPS. METHODS This retrospective study enrolled patients with severe EPS who underwent surgical enterolysis in a tertiary referral medical center. The association of CT score with surgical outcomes including mortality, blood loss, and bowel perforation was analyzed. RESULTS Thirty-four patients who underwent 37 procedures were recruited and divided into a survivor and non-survivor group. The survivor group had higher body mass indices (BMIs, 18.1 vs. 16.7 kg/m2, p = 0.035) and lower CT scores (11 vs. 17, p < 0.001) than the non-survivor group. The receiver operating characteristic curve revealed that a CT score of ≥15 could be considered a cutoff point to predict surgical mortality, with an area under the curve of 0.93, sensitivity of 88.9%, and specificity of 82.1%. Compared with the group with CT scores of <15, the group with CT scores of ≥15 had a lower BMI (19.7 vs. 16.2 kg/m2, p = 0.004), higher mortality (4.2% vs. 61.5%, p < 0.001), greater blood loss (50 vs. 400 mL, p = 0.007), and higher incidence of bowel perforation (12.5% vs. 61.5%, p = 0.006). CONCLUSION The CT scoring system could be useful in predicting surgical risk in patients with severe EPS receiving enterolysis.
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Affiliation(s)
- Chih-Jung Wang
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ying Jui Chao
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Sheng Liu
- Department of Radiology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Fan-Ting Liao
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shen-Shin Chang
- Division of Transplantation, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ting-Kai Liao
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wei-Hsun Lu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ping-Jui Su
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yan-Shen Shan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan.
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4
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Wen YK. Diagnostic dilemma of bowel perforation in a peritoneal dialysis patient with encapsulating peritoneal sclerosis. Clin Nephrol 2023; 100:193-194. [PMID: 37577769 DOI: 10.5414/cn111185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 08/15/2023] Open
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5
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Chorti A, Panidis S, Konstantinidis D, Cheva A, Papavramidis T, Michalopoulos A, Paramythiotis D. Abdominal cocoon syndrome: Rare cause of intestinal obstruction-Case report and systematic review of literature. Medicine (Baltimore) 2022; 101:e29837. [PMID: 35801789 PMCID: PMC9259168 DOI: 10.1097/md.0000000000029837] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Abdominal cocoon or sclerosing encapsulating peritonitis is an uncommon condition in which the small bowel is completely or partially encased by a thick fibrotic membrane. Our study presents a case of sclerosing encapsulating peritonitis and conducts a literature review. METHODS A bibliographic research was conducted. Our research comprised 97 articles. Gender, age, symptoms, diagnostic procedures, and treatment were all included in the database of patient characteristics. CASE PRESENTATION A 51-year-old man complaining of a 2-day history of minor diffuse abdominal pain, loss of appetite, and constipation was presented in emergency department. Physical examination was indicative of intestinal obstruction. Laboratory tests were normal. Diffuse intraperitoneal fluid and dilated small intestinal loops were discovered on computed tomography (CT). An exploratory laparotomy was recommended, in which the sac membrane was removed and adhesiolysis was performed. He was discharged on the tenth postoperative day. RESULTS There were 240 cases of abdominal cocoon syndrome in total. In terms of gender, 151 of 240 (62.9%) were male and 89 of 240 (37%) were female. Ages between 20 and 40 are most affected. Symptoms include abdominal pain and obstruction signs. For the diagnosis of abdominal cocoon syndrome, CT may be the gold standard imaging method. The surgical operation was the treatment of choice in the vast majority of cases (96.7%). Only 69 of 239 patients (28.9%) were detected prior to surgery, and CT was applied in these cases. CONCLUSION Abdominal cocoon is a rare condition marked by recurrent episodes of intestinal obstruction. Surgical therapy is the most effective treatment option.
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Affiliation(s)
- Angeliki Chorti
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- *Correspondence: Angeliki Chorti, 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, St Kiriakidi 1, 54621 Thessaloniki, Greece (e-mail: )
| | - Stavros Panidis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Konstantinidis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angeliki Cheva
- Department of Pathology, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodossis Papavramidis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Michalopoulos
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Daniel Paramythiotis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Win KM, Castelhano R, Dasgupta T. Concurrent development of encapsulating peritoneal sclerosis and calciphylaxis in a patient with peritoneal dialysis for end-stage renal disease. BMJ Case Rep 2022; 15:e245156. [PMID: 35321908 PMCID: PMC8943729 DOI: 10.1136/bcr-2021-245156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 12/29/2022] Open
Abstract
Both encapsulating peritoneal sclerosis (EPS) and calciphylaxis are rare but severe complications involving patients with end-stage renal disease. In this report, we discuss a unique case of a 73-year-old female patient who had undergone 8 years of peritoneal dialysis for IgA nephropathy and concurrently developed these two synchronous complications within 3 months of each other. Diagnosis and management of both conditions were discussed in detail as well as the possible association between the two. With surgical treatment for EPS and measures to minimise bone mineral disorder abnormalities, both complications have been successfully managed to date.
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Affiliation(s)
- Khine Myat Win
- Trauma and Orthopaedics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rute Castelhano
- Emergency General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - Tanaji Dasgupta
- Swindon Renal Unit, Great Western Hospital Foundation NHS Trust, Swindon, UK
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7
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Keese D, Schmedding A, Saalabian K, Lakshin G, Fiegel H, Rolle U. Abdominal cocoon in children: A case report and review of literature. World J Gastroenterol 2021; 27:6332-6344. [PMID: 34712036 PMCID: PMC8515801 DOI: 10.3748/wjg.v27.i37.6332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/30/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Abdominal cocoon or “encapsulating peritoneal sclerosis” (EPS) is an uncommon and rare cause of intestinal obstruction. Only a few cases have been reported in paediatric patients. Typically, EPS is described as the primary form in young adolescent girls from tropical and subtropical countries because of viral peritonitis due to retrograde menstruation or a history of peritoneal dialysis. Most patients are asymptomatic or present with abdominal pain, which is likely to occur secondary to subacute bowel obstruction. Findings at imaging, such as ultrasound, computed tomography, and magnetic resonance imaging, are often nonspecific. When diagnosed, EPS is characterized by total or partial encasement of the bowel within a thick fibrocollagenous membrane that envelopes the small intestine in the form of a cocoon because of chronic intraabdominal fibroinflammatory processes. The membrane forms a fibrous tissue sheet that covers, fixes, and finely constricts the gut, compromising its motility.
CASE SUMMARY We present a case of EPS in a 12-year-old boy 8 wk after primary surgery for resection of symptomatic jejunal angiodysplasia. There was no history of peritoneal dialysis or drug intake.
CONCLUSION In this report, we sought to highlight the diagnostic, surgical, and histopathological characteristics and review the current literature on EPS in paediatric patients.
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Affiliation(s)
- Daniel Keese
- Goethe-University Frankfurt, Department of Paediatric Surgery and Paediatric Urology, University Hospital, Frankfurt 60590, Germany
| | - Andrea Schmedding
- Goethe-University Frankfurt, Department of Paediatric Surgery and Paediatric Urology, University Hospital, Frankfurt 60590, Germany
| | - Kerstin Saalabian
- Goethe-University Frankfurt, Department of Paediatric Surgery and Paediatric Urology, University Hospital, Frankfurt 60590, Germany
| | - Georgy Lakshin
- Goethe-University Frankfurt, Department of Paediatric Surgery and Paediatric Urology, University Hospital, Frankfurt 60590, Germany
| | - Henning Fiegel
- Goethe-University Frankfurt, Department of Paediatric Surgery and Paediatric Urology, University Hospital, Frankfurt 60590, Germany
| | - Udo Rolle
- Goethe-University Frankfurt, Department of Paediatric Surgery and Paediatric Urology, University Hospital, Frankfurt 60590, Germany
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8
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Sinagra E, Buscaglia F, Iacoponelli A, Sciumè C. Encapsulating peritoneal sclerosis: do not be too late for the right diagnosis! Case report and short literature review. G Chir 2019; 40:343-347. [PMID: 32011990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare clinical syndrome characterized by an acquired, inflammatory fibrocollagenous membrane encasing the small intestine, resulting in symptoms of bowel obstruction. It is still unclear whether early surgical intervention has an advantage over conservative management, but, in most reviewed case reports, it is preferred to preserve the surgical management in patients not responding to conservative measures, or when bowel ischaemia is occurring. We report a case of a 58-year old patients, affected by chronic renal failure, on treatment with peritoneal dialysis, in which a late diagnosis of encapsulating peritoneal sclerosis was made, and where surgical intervention was not sufficient to guarantee survival due to the late diagnosis.
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9
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Li Cavoli G, Amato A, Mongiovì R, Schillaci O, Giammarresi C, Bono L, Turdo R, Carollo C, Zagarrigo C, Servillo F, Oliva B, Tralongo A, Caputo F. Early Histological Changes in Post-Transplant Encapsulating Peritoneal Sclerosis. Blood Purif 2018; 46:323-325. [PMID: 30107376 DOI: 10.1159/000491873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/05/2018] [Indexed: 11/19/2022]
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10
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Peker E, Erden A, Erden İ, Törüner M. A rare cause of small bowel obstruction. Turk J Gastroenterol 2018; 29:237-238. [PMID: 29749335 PMCID: PMC6284717 DOI: 10.5152/tjg.2018.17478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/06/2017] [Indexed: 06/08/2023]
Affiliation(s)
- Elif Peker
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Ayşe Erden
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - İlhan Erden
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Murat Törüner
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
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11
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Tolstrup J, Lauritsen ML. [Abdominal cocoon syndrome in an eigth-year-old girl caused acute bowel obstruction]. Ugeskr Laeger 2017; 179:V05170380. [PMID: 29260698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This case report describes an eight-year-old girl who was admitted under the suspicion of gastroenteritis. The physical examination revealed symptoms of acute bowel obstruction, which was confirmed by abdominal CT scan. Explorative laparotomy showed a fibrotic membrane encapsulating the small intestine causing obstruction and ischaemia, and the perioperative diagnosis was abdominal cocoon syndrome. Two metres of the small intestine, excessive peritoneal membrane and the appendix was resected and an ileostomy was performed. The patient recovered with antibiotics, fluid therapy and parenteral nutrition.
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12
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Brown MA, Schermerhorn B, White C, Bates W. Trauma-Associated Abdominal Cocoon: Demonstration of Radiographic Evolution. Am Surg 2017; 83:e297-e299. [PMID: 28822366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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13
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Abstract
RATIONALE Abdominal cocoon and peritoneal loose body are both rare abdominal diseases. PATIENT CONCERNS The patient reported in this case was a 47-year-old man who suffered from abdominal pain and distension for 3 days. DIAGNOSIS X-ray, computed tomography, and magnetic resonance imaging revealed multiple peritoneal loose body and small bowel obstruction, characterized by a total encapsulation of the small bowel with a fibrous membrane. INTERVENTIONS The patient underwent surgical treatment and exploratory laparotomy confirmed the diagnosis of abdominal cocoon. OUTCOMES Histopathological examination of pelvic nodules confirmed peritoneal loose body. LESSONS To our knowledge, the herein reported case is the first abdominal cocoon that was accompanied by multiple peritoneal loose body.
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Affiliation(s)
- Yongyuan Cheng
- Department of Radiology, Yantai Municipal Laiyang Central Hospital
| | - Lintao Qu
- Department of Radiology, Yantai Municipal Laiyang Central Hospital
| | - Jun Li
- Medical Imaging Research Institute, Binzhou Medical University
| | - Bin Wang
- Medical Imaging Research Institute, Binzhou Medical University
| | - Junzu Geng
- Medical Imaging Research Institute, Binzhou Medical University
| | - Dong Xing
- Department of Radiology, Yantai Yuhuangding Hospital, Medical College of Qingdao University, Yantai, Shandong, China
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14
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Bell CM, Dart BW. Abdominal Cocoon-An Unusual Case of Bowel Obstruction. Am Surg 2016; 82:308-309. [PMID: 28206919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Christopher M Bell
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Chattanooga, Tennessee, USA
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15
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Kalantarian TS, Najafi I. A New Experience With Encapsulating Peritoneal Sclerosis: Role of Early Intervention. Iran J Kidney Dis 2016; 10:264-273. [PMID: 27721224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 05/07/2016] [Indexed: 06/06/2023]
Abstract
After 20 years of peritoneal dialysis in Iran, we have encountered with several cases of encapsulating peritoneal sclerosis (EPS) in past few years. Many of these cases remained undiagnosed until advanced stages due to lack of suspicion. In centers with more experience about EPS, mortality has decreased by early diagnostic interventions. Peritoneal dialysis nurses may not be aware of EPS and radiologists are usually not familiar with EPS, either. To increase knowledge about this condition, we decided to present this review article with the case study of one of the 1st patients with EPS at our center. Currently, we have had no data registry of EPS in Iran, yet. Our plan is to develop a national EPS registry in our country which will help to closely monitor these patients.
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Affiliation(s)
- Tahere Sadat Kalantarian
- Division of Nephrology, Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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van Tienhoven AJ, van Turenhout ST, Jensch S, Van Veen RN, Veenstra J. A butterfly in the belly: an unusual cause of intestinal obstruction. Neth J Med 2016; 74:218-219. [PMID: 27323677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- A J van Tienhoven
- Department of Internal Medicine, OLVG-West, Amsterdam, the Netherlands
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De Oleo RR, Villanueva H, Lwin L, Katikaneni M, Yoo J. Time Is Not Always the Matter: An Instance of Encapsulating Peritoneal Sclerosis Developing in a Patient on Peritoneal Dialysis for a Short Term. Adv Perit Dial 2016; 32:19-21. [PMID: 28988585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Encapsulating peritoneal sclerosis (EPS) is an infrequent but serious complication that is observed mostly in patients on long-term peritoneal dialysis (PD). However it can occur after short-term PD, in association with "second hit" risk factors such as peritonitis, acute cessation of PD, or kidney transplantation with the use of calcineurin inhibitors.In our case, a young woman with second-hit risk factors presented with clinical and abdominal computed tomography findings consistent with EPS after short-term PD. She was treated conservatively with nutritional support and was discharged in improved and stable clinical status.In general, the diagnosis of EPS requires clinical findings of bowel obstruction combined with typical computed tomography imaging features. However, the clinical manifestations can be very vague, and the diagnosis is often unclear. A recent study categorized EPS into 4 clinical stages, from pre-EPS to chronic ileus, with associated management from conservative treatment to surgical intervention.In association with second-hit risk factors, EPS can occur after short-term PD. Severity is variable, and the outcome is often devastating. Timely recognition and expert management of EPS can change the outcome very favorably.
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Affiliation(s)
| | - Hugo Villanueva
- Montefiore Medical Center, Wakefield Campus, Bronx, New York, U.S.A
| | - Lin Lwin
- Montefiore Medical Center, Wakefield Campus, Bronx, New York, U.S.A
| | | | - Jinil Yoo
- Montefiore Medical Center, Wakefield Campus, Bronx, New York, U.S.A
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18
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Duus RM, Brodersen LA, Colic E. [Encapsulating peritoneal sclerosis in a patient who had previously been in peritoneal dialysis]. Ugeskr Laeger 2014; 176:V11120639. [PMID: 25497645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare but potentially fatal complication to long-term peritoneal dialysis (PD). We describe a case of EPS in a 58-year-old patient who had formerly had PD. The interdisciplinary approach for diagnosis and possible treatments in this condition is discussed.
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Affiliation(s)
- Rasmus Møller Duus
- Nefrologisk Afdeling Y, Odense Universitetshospital, Sdr. Boulevard 29, 5000 Odense C.
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Ichinose K, Ohtsubo T, Kawakami A. [Rare case of systemic lupus erythematosus with encapsulating peritoneal sclerosis during hemodialysis]. Nihon Jinzo Gakkai Shi 2014; 56:138-144. [PMID: 24730352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 57-year old male patient was admitted to our hospital because of severe vomiting and abdominal pain with massive ascites. He had been diagnosed as mixed connective tissue disease in 1997 and lupus nephritis ISN III (A/C) + V in 2003. Treatment was started with intravenous steroid pulse therapy combined with an immunosuppressant resulting in improvement of his proteinuria and serological activity. In 2008, the disease activity flared and he was admitted to our hospital with nephrotic syndrome. Hemodialysis was unavoidable, despite treatment with intravenous steroid pulse therapy and plasma exchange. We continued to treat him with oral prednisolone and tacrolimus. However, for personal reasons, he terminated tacrolimus treatment and massive ascites remained because of insufficient hemodialysis. Since the end of 2011, he suffered repeated abdominal pain with ileus and encapsulating peritoneal sclerosis (EPS) was detected. In February 2013, he underwent synechotomy for EPS. Here, we present a rare case of EPS in a hemodialysis patient.
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Upponi S, Butler AJ, Watson CJE, Shaw AS. Encapsulating peritoneal sclerosis--correlation of radiological findings at CT with underlying pathogenesis. Clin Radiol 2013; 69:103-9. [PMID: 24209872 DOI: 10.1016/j.crad.2013.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 08/29/2013] [Accepted: 08/29/2013] [Indexed: 12/11/2022]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare entity most commonly associated with peritoneal dialysis (PD). Several imaging features at computed tomography (CT) are common to many diseases; however, appreciation of the features unique to this condition interpreted with the appropriate clinical findings is crucial to diagnosis.
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Affiliation(s)
- S Upponi
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - A J Butler
- Academic Department of Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - C J E Watson
- Academic Department of Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - A S Shaw
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK.
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21
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Abstract
Sclerosing encapsulating peritonitis, previously referred to as cocoon bowel, is a rare cause of intestinal obstruction that often results in obstruction due to the development of a fibrous enhancing membrane that encases multiple small bowel loops. We present a case of a patient who presented to our institution with abdominal distension and guarding. Computed tomography was obtained which revealed findings concerning for sclerosing encapsulating peritonitis. Sonographic imaging was also obtained and provides correlative imaging.
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Affiliation(s)
- Jason Caldwell
- Department of Radiology, Methodist University Hospital, Memphis, TN, USA
| | - Andrew Dyer
- Department of Radiology, Methodist University Hospital, Memphis, TN, USA
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22
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Laugesen KB, Ljungmann K. [Abdominal cocoon is a rare cause of ileus]. Ugeskr Laeger 2013; 175:1424-1425. [PMID: 23663399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Partial or total encapsulation of bowel in a membrane-like sac is a rare cause of mechanical bowel obstruction. Three different types of encapsulation have been described: a congenital, a secondary and an idiopathic or "abdominal cocoon". The present case describes a 34-year-old male, who was admitted with small bowel obstruction caused by an "abdominal cocoon", which was successfully treated by surgery. Precise preoperative diagnosis is often missed, but a computed tomography visualizing bowel loops enclosed in a membrane is a characteristic finding.
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23
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Wang YC, Lin HM, Ting IW, Liu JH. Encapsulating peritoneal sclerosis. Intern Med 2012; 51:123. [PMID: 22214638 DOI: 10.2169/internalmedicine.51.6670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yung-Chin Wang
- Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taiwan
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24
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Raina R, Schreiber MJ, Gebreselassie S. Chronic abdominal pain in a patient on maintenance peritoneal dialysis. Adv Perit Dial 2011; 27:87-89. [PMID: 22073836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Encapsulating peritoneal sclerosis (EPS) is an uncommon but one of the most serious complications in patients on long-term peritoneal dialysis (PD). The diffuse thickening and sclerosis of the peritoneal membrane that characterizes EPS leads to decreased ultrafiltration and ultimately to bowel obstruction. Given that the prognosis of established EPS is poor, early recognition of the preceding symptoms is essential. Computed tomography of the abdomen is a reliable and noninvasive diagnostic tool. Typical computed tomography features of EPS include peritoneal calcification, bowel wall thickening, peritoneal thickening, loculated fluid collections, and tethered bowel loops. These findings are diagnostic of EPS in the appropriate clinical setting. Here we present a case report of chronic abdominal pain in a patient on maintenance PD representing a case of EPS.
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Affiliation(s)
- Rupesh Raina
- Department of Nephrology and Hypertension, Glickman Urology and Kidney Institute at Cleveland Clinic Foundation, Cleveland, Ohio, USA
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25
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Abstract
We describe a rare case of left mesocolic hernia presenting as post appendicectomy intestinal obstruction in a girl. Laparotomy confirmed partial peritoneal encapsulation of upper small bowel due to herniation of jejunal loops into the left mesocolic hernia sac. Reduction of contents, resection of the sac and repair of the defect concluded the procedure uneventfully.
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Affiliation(s)
- Ramnik Patel
- Department of Pediatrics Surgery University Hospital of Leicester, PGIMER, Chandigarh, India
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26
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Térébus Loock M, Lubrano J, Courivaud C, Bresson Vautrin C, Kastler B, Delabrousse E. CT in predicting abdominal cocoon in patients on peritoneal dialysis. Clin Radiol 2010; 65:924-9. [PMID: 20933648 DOI: 10.1016/j.crad.2010.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 06/03/2010] [Accepted: 06/10/2010] [Indexed: 12/12/2022]
Abstract
AIM To evaluate the computed tomography (CT) signs of encapsulating peritoneal sclerosis (EPS) in patients on peritoneal dialysis (PD) as predictive factors for the evolution to abdominal cocoon (AC). MATERIALS AND METHODS Clinical features and CT signs of 90 patients on PD were retrospectively reviewed. According to the clinical features, they were divided into three groups (asymptomatic, moderate, or severe). Clinical results were correlated with previously reported CT signs of EPS, i.e., peritoneal thickening, peritoneal calcifications, loculated fluids, small bowel faeces sign, small bowel obstruction, clustered bowel loops, pseudo sac, signs of bowel ischaemia or necrosis. AC was defined at CT by the association of clustered bowel loops and a pseudo sac. Statistical analysis was performed using the Fisher's exact test and the t-test. RESULTS Although demonstrated in symptomatic patients (p=0.041), the occurrence of AC was not correlated with the severity of the symptoms (p=0.16). Among the CT signs, the presence of loculated fluids (p=0.011), a small bowel faeces sign (p=0.002); and small bowel obstruction (p=0.0001) were found to be statistically correlated with the appearance of an AC. Moreover, the association of loculated fluids, small bowel faeces sign, small bowel obstruction was extremely sensitive and specific in the development of AC (sensitivity=67%, specifity=100%, positive predictive value=100%, negative predictive value=96%). CONCLUSION CT should be carried out in every symptomatic patient on PD. Indeed, the association of loculated fluid, small bowel faeces sign, and small bowel obstruction enables the prediction of the development of AC, which is likely to curtail PD and require surgery.
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Sternberg ML, Woodward A. Encapsulating peritoneal sclerosis. J Emerg Med 2010; 39:95-96. [PMID: 18571363 DOI: 10.1016/j.jemermed.2007.11.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Revised: 07/23/2007] [Accepted: 11/07/2007] [Indexed: 05/26/2023]
Affiliation(s)
- Michael L Sternberg
- Department of Emergency Medicine, University of South Alabama Medical Center, Mobile, Alabama 36617, USA
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Bansal S, Sheth H, Siddiqui N, Bender FH, Johnston JR, Piraino B. Incidence of encapsulating peritoneal sclerosis at a single U.S. university center. Adv Perit Dial 2010; 26:75-81. [PMID: 21348385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a life-threatening complication of peritoneal dialysis. Few data are available from the United States about the incidence of EPS over time. To examine that question, we retrospectively examined our PD registry, in existence for 30 years, to identify patients with EPS. All other data were collected prospectively. We asked a radiologist to review all computed tomography (CT) scans taken at the time of EPS diagnosis. Incidence of EPS in our 676 patients was 1.2%, but rose to 15% after 6 years, and 38% after 9 years on PD. Peritonitis rates were not high in patients that developed EPS. Scoring of CT scans confirmed the diagnosis of EPS in all patients. Treatment was variable, but in recent years, steroids and tamoxifen were generally used when EPS was recognized. Mortality related to EPS was 38%. Several years after diagnosis, 3 patients are still alive; none is on total parenteral nutrition. In summary, the risk of EPS is low early in the course of PD, but increases progressively at 6 years and beyond. Imaging by CT is useful for diagnosing EPS. Our preliminary results suggest that steroids and tamoxifen are beneficial. Multicenter studies on this serious problem are needed.
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Affiliation(s)
- Saurabh Bansal
- Renal Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Vlijm A, Stoker J, Bipat S, Spijkerboer AM, Phoa SSKS, Maes R, Struijk DG, Krediet RT. Computed tomographic findings characteristic for encapsulating peritoneal sclerosis: a case-control study. Perit Dial Int 2009; 29:517-522. [PMID: 19776044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Computed tomography (CT) is often used to confirm the diagnosis of encapsulating peritoneal sclerosis (EPS) but there is no consensus on specific CT abnormalities. To establish CT findings characteristic for EPS, we compared CT findings between EPS patients and long-term peritoneal dialysis (PD) patients without EPS. METHODS We included as cases all EPS patients in our center from 1996 to 2008 that underwent a CT scan at the time of diagnosis. Controls were all other long-term PD patients (PD duration > or = 4 years) without EPS that had a CT scan for different reasons. The CT scans were blindly and independently reviewed by 3 radiologists: 2 abdominal radiologists with PD knowledge (Observers 1 and 2) and 1 radiologist without PD experience (Observer 3). RESULTS We included 15 EPS patients and 16 controls. Observer 1 found 6 CT findings that were significantly more often present in EPS than in controls (p < or = 0.05): peritoneal enhancement, thickening, and calcifications; adhesions of bowel loops; signs of obstruction; and fluid loculation/septation. Observer 2 scored almost identically but Observer 3 scored differently. The sensitivity and specificity of a combination of specific CT findings were, respectively, 100% and 94% for Observers 1 and 2, and 79% and 88% for Observer 3. CONCLUSION CT scans showed characteristic abnormalities that were significantly more often present in EPS patients compared to long-term PD control patients. CT can be used to confirm the diagnosis of EPS when experienced radiologists apply a combination of specific CT findings.
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Affiliation(s)
- Anniek Vlijm
- Department of Medicine, University of Amsterdam, Amsterdam, The Netherlands.
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30
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Brown EA. Computed tomographic scanning and diagnosis of encapsulating peritoneal sclerosis. Perit Dial Int 2009; 29:502-504. [PMID: 19776041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- Edwina A Brown
- Imperial College Kidney and Transplant Institute, Hammersmith Hospital London, UK.
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