|
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 PMCID: PMC11227164 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
|
Ayoub M, Ouazni M, Achraf M, Sanae A, Mehdi S. Surgical management of sclerosing encapsulating peritonitis (SEP) secondary to tuberculosis: A case report and review of the literature. Int J Surg Case Rep 2024; 115:109292. [PMID: 38271865 PMCID: PMC10818070 DOI: 10.1016/j.ijscr.2024.109292] [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: 11/12/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Sclerosing encapsulating peritonitis (SEP), commonly known as abdominal cocoon syndrome (ACS), is considered one of the rare causes of bowel obstruction [1]. CASE PRESENTATION In this article, we report the case of a 20-year-old male patient with a 6-month history of recurrent colicky right-sided upper abdominal pain accompanied by nausea, vomiting and bloating, which gradually increased in severity and frequency. The contrast-enhanced abdominal computed tomography suggested a small bowel obstruction with a differential diagnosis of SEP. Later exploratory laparotomy and histopathological examination confirmed the diagnosis of ACS. Intraoperative adhesiolysis was performed and the patient's symptoms resolved. DISCUSSION This syndrome is characterised by the formation of a fibrous-collagenous membrane that partially or completely engulfs the small intestine, less commonly the colon and other abdominal organs. SEP is most commonly associated with long-term peritoneal dialysis, although drugs, peritoneal infection and systemic inflammatory disorders have been implicated. Patients often present with symptoms of partial bowel obstruction, which is difficult to diagnose before laparotomy. Of the available investigations, contrast-enhanced CT of the abdomen is the most sensitive, showing a fibrous sac-like membrane covering the intestinal loops and the fluid collection. Definitive treatment includes excision and adhesiolysis. CONCLUSION This article presents a rare case and focuses on the management of this pathology with a review of the literature.
Collapse
Affiliation(s)
- Madani Ayoub
- Department of General Surgery, Souss Massa University Hospital Centre, Agadir, Faculty of Medicine and Pharmacy Agadir, Morocco.
| | - Mohammed Ouazni
- Department of General Surgery, Souss Massa University Hospital Centre, Agadir, Faculty of Medicine and Pharmacy Agadir, Morocco
| | - Miry Achraf
- Department of Anatomopathology, Souss Massa University Hospital Centre, Agadir, Faculty of Medicine and Pharmacy Agadir, Morocco
| | - Abbaoui Sanae
- Department of Anatomopathology, Souss Massa University Hospital Centre, Agadir, Faculty of Medicine and Pharmacy Agadir, Morocco
| | - Soufi Mehdi
- Department of General Surgery, Souss Massa University Hospital Centre, Agadir, Faculty of Medicine and Pharmacy Agadir, Morocco
| |
Collapse
|
|
3
|
Ray AK, Chandra A, Samanta K, Chakraborty U, Dey D, Dhar KK. Abdominal cocoon-An uncommon cause of intestinal obstruction. Indian J Gastroenterol 2023; 42:146-147. [PMID: 33860923 DOI: 10.1007/s12664-021-01164-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Aritra Kumar Ray
- Department of Internal Medicine, R G Kar Medical College and Hospital, Kolkata 700 004, India
| | - Atanu Chandra
- Department of Internal Medicine, R G Kar Medical College and Hospital, Kolkata 700 004, India.
| | - Kaustav Samanta
- Department of General Surgery, R G Kar Medical College and Hospital, Kolkata 700 004, India
| | - Uddalak Chakraborty
- Department of Internal Medicine, R G Kar Medical College and Hospital, Kolkata 700 004, India
| | - Debasish Dey
- Department of Radiodiagnosis, R G Kar Medical College and Hospital, Kolkata 700 004, India
| | - Kingshuk Kumar Dhar
- Department of Gastroenterology, R G Kar Medical College and Hospital, Kolkata 700 004, India
| |
Collapse
|
|
4
|
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: 2.0] [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
|
|
5
|
Mousavi MA, Shaghaghi A, Sabouri M, Yousefian R. Abdominal cocoon syndrome as rare cause of intestinal obstruction: A case report. Int J Surg Case Rep 2022; 98:107547. [PMID: 36057246 PMCID: PMC9482919 DOI: 10.1016/j.ijscr.2022.107547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/21/2022] [Accepted: 08/21/2022] [Indexed: 02/07/2023] Open
|
|
6
|
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: 5.0] [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
|
|
7
|
Keshvari A, Ettehadi R, Azadnajafabad S, Keramati MR. Encapsulated Peritoneal Sclerosis due to Peritoneal Dialysis: Long-Term Experience Following Surgical Operation. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03339-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
|
8
|
Abdur Raheem J, Annu SC, Ravula L, Samreen S, Khan A. Is Abdominal Cocoon a Sequela in Recovered Cases of Severe COVID-19? Cureus 2022; 14:e22384. [PMID: 35371817 PMCID: PMC8936210 DOI: 10.7759/cureus.22384] [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: 02/19/2022] [Indexed: 11/30/2022] Open
Abstract
Abdominal cocoon is one of the rare causes of intestinal obstruction mostly diagnosed at the operating table. Its etiology is primarily unknown but can be secondary to known causes. The involvement of the gastrointestinal (GI) system was a common feature during the second wave of COVID-19, and at present, there are reports of GI symptoms in patients who have completely recovered from COVID-19. Abdominal cocoon formation has been reported during the active stage of COVID-19 but not as its sequela. We report two cases with a high degree of suspicion of abdominal cocoon formation in middle-aged individuals with no comorbidities, who recovered from a severe form of COVID-19.
Collapse
|
|
9
|
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: 1.0] [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
|
|
10
|
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
|
|
11
|
Agarwal S, Gaur K, Agrawal N, Puri A. Supernumerary Remnant Vas Deferens Like Wolffian-Derivatives in a Young Child With Abdominal Cocoon Syndrome-A Clinicopathological Novelty. Pediatr Dev Pathol 2021; 24:455-459. [PMID: 33749382 DOI: 10.1177/10935266211001639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The abdominal cocoon syndrome is a rare cause of recurring intestinal obstruction in children. It refers to encasement of the small bowel by a fibrocollagenous membrane forming a cocoon. We report a nine year old male presenting with abdominal pain, distension, bilious vomiting and inability to pass stool and flatus for two days. In view of a persistently increasing bilious nasogastric output, an urgent exploratory laparotomy was performed. The small bowel loops were matted together forming a cocoon densely adherent to the parietal peritoneum with supra-colic fibrous bands. The bands histologically displayed multiple ductal remnants with epithelium resembling that of ductus deferens. These structures showed immunopositivity for pan-cytokeratin and basal CD10.Workup for tuberculosis and other etiological causes was unremarkable. This is the first documented case of abdominal cocoon in a pediatric subject associated with supernumerary wolffian remnants.
Collapse
Affiliation(s)
- Shilpi Agarwal
- Department of Pathology, Lady Hardinge Medical College, Shaheed Bhagat Singh Marg, New Delhi, India
| | - Kavita Gaur
- Department of Pathology, Lady Hardinge Medical College, Shaheed Bhagat Singh Marg, New Delhi, India
| | - Nikita Agrawal
- Department of Pathology, Lady Hardinge Medical College, Shaheed Bhagat Singh Marg, New Delhi, India
| | - Archana Puri
- Department of Pediatric Surgery, Lady Hardinge Medical College, Shaheed Bhagat Singh Marg, New Delhi, India
| |
Collapse
|
|
12
|
Bhatta OP, Verma R, Shrestha G, Sharma D, Dahal R, Kansakar PBS. An unusual case of intestinal obstruction due to abdominal cocoon: A case report. Int J Surg Case Rep 2021; 85:106282. [PMID: 34388909 PMCID: PMC8358643 DOI: 10.1016/j.ijscr.2021.106282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Abdominal cocoon (AC) or Encapsulating Peritoneal Sclerosis (EPS) is a rare cause of bowel obstruction and due to non-specific presentation, it can be misdiagnosed and often mistreated. CASE PRESENTATION We present the case of 42 years male with a history suggestive of complete small bowel obstruction (SBO) without a history of pulmonary tuberculosis (TB) or peritoneal dialysis. CT imaging as well as the intraoperative finding of a cocoon membrane encasing the small bowel led to the diagnosis of abdominal cocoon. CLINICAL DISCUSSION Abdominal cocoon can be idiopathic or secondary to peritoneal dialysis, tuberculosis, or other rare causes. Patients usually present with features of SBO with varying severity. Diagnosis is aided by imaging investigations mainly CT scan and management is primarily surgical and usually involves adhesiolysis, total removal of the membrane with or without bowel loop resection. CONCLUSION Diagnosis of abdominal cocoon warrants awareness of the disease and a high index of suspicion of the treating clinician in patients with intestinal obstruction and an abdominal lump without a history of previous abdominal surgery. CT can guide diagnosis and early operative management seems to bear the best outcomes.
Collapse
Affiliation(s)
- Om Prakash Bhatta
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.
| | - Rupesh Verma
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Gyaneswor Shrestha
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Deepak Sharma
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Romi Dahal
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Prasan Bir Singh Kansakar
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| |
Collapse
|
|
13
|
Karona P, Blevrakis E, Kastanaki P, Tzouganakis A, Kastanakis M. Abdominal Cocoon Syndrome: An Extremely Rare Cause of Small Bowel Obstruction. Cureus 2021; 13:e14351. [PMID: 33972908 PMCID: PMC8105234 DOI: 10.7759/cureus.14351] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Abdominal cocoon syndrome or encapsulating peritoneal sclerosis is a rare condition causing small bowel obstruction. It is called cocoon syndrome because of the existence of an abnormal membrane that contains part or the entire small intestine. We present a case of a 49-year-old male, presenting to our department with recurrent episodes of obstructive ileus that did not respond to conservative treatment. He underwent exploratory laparotomy and a thick membrane covering the small bowel loops was found. The membrane was excised and sent for pathological examination. Abdominal cocoon syndrome is an acquired condition caused by an inflammatory process that is not yet completely understood. There are many theories for the pathophysiology of the disease. In most cases, the diagnosis is established during surgery. Complete removal of the membrane is the indicated surgical treatment. In mild cases, when the diagnosis is made preoperatively, conservative treatment should be the first choice.
Collapse
Affiliation(s)
- Paraskevi Karona
- First Department of Surgery, Saint George General Hospital of Chania, Chania, GRC
| | - Evangelos Blevrakis
- Pediatric Surgery Department, Saint George General Hospital of Chania, Chania, GRC
| | - Pagona Kastanaki
- First Department of Surgery, Saint George General Hospital of Chania, Chania, GRC
| | - Aggelos Tzouganakis
- First Department of Surgery, Saint George General Hospital of Chania, Chania, GRC
| | - Miltiades Kastanakis
- First Department of Surgery, Saint George General Hospital of Chania, Chania, GRC
| |
Collapse
|
|
14
|
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
|
|
15
|
Plotkin DV, Reshetnikov MN, Kharitonov SV, Sokolina IA, Pryadkin AA, V Sinitsyn M. [Tuberculous abdominal cocoon as a rare variant of peritonitis]. Khirurgiia (Mosk) 2020:24-30. [PMID: 32573528 DOI: 10.17116/hirurgia202006124?] [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: 11/17/2022]
Abstract
OBJECTIVE To study and systematize clinical symptoms of tuberculous perivisceritis, to clarify diagnostic value of laboratory and instrumental survey in these patients and to identify the features of surgical treatment. MATERIAL AND METHODS There were 8 patients with tuberculous perivisceritis. Examination included computed tomography of the abdominal cavity and chest, ultrasound, laparoscopy. All patients underwent surgical treatment with histological, cytological, microbiological and molecular genetic analysis of peritoneal exudate and biopsy of peritoneal specimens. RESULTS Clinical picture of tuberculous perivisceritis is variable and non-specific. Periods of exacerbation are replaced by periods of prolonged remission. The complex of radiological survey used in verification of perivisceritis does not allow accurate determining the nature of disease. However, peritoneal tuberculosis may be suspected as a rule considering signs of thickening of the peritoneum. Objective confirmation of perivisceritis is possible only during surgical intervention. In this case, etiological factor can be established only after a thorough histological examination of resected fibrous capsule. CONCLUSION Clinical picture of tuberculous perivisceritis does not have specific symptoms. The disease is characterized by prolonged and undulating course. Acute peritonitis and acute intestinal obstruction may be suspected during exacerbation of the pathological process. Laparotomy followed by complete excision of fibrous capsule and adhesiolysis is preferred.
Collapse
Affiliation(s)
- D V Plotkin
- Moscow Scientific and Practical Center for TB Control of the Moscow Healthcare Department, Moscow, Russia.,Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - M N Reshetnikov
- Moscow Scientific and Practical Center for TB Control of the Moscow Healthcare Department, Moscow, Russia
| | - S V Kharitonov
- Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - I A Sokolina
- Moscow Scientific and Practical Center for TB Control of the Moscow Healthcare Department, Moscow, Russia
| | - A A Pryadkin
- Moscow Scientific and Practical Center for TB Control of the Moscow Healthcare Department, Moscow, Russia
| | - M V Sinitsyn
- Moscow Scientific and Practical Center for TB Control of the Moscow Healthcare Department, Moscow, Russia
| |
Collapse
|
|
16
|
Gaszynski R, Gray A, Apostolou C, Merrett N. Laparoscopic diagnosis and management of peritonitis chronica fibrosa incapsulata. ANZ J Surg 2020; 90:1795-1796. [PMID: 31919966 DOI: 10.1111/ans.15673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/19/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Rafael Gaszynski
- Department of Upper Gastrointestinal Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Andrew Gray
- Department of Upper Gastrointestinal Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Christos Apostolou
- Department of Upper Gastrointestinal Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Neil Merrett
- Department of Upper Gastrointestinal Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| |
Collapse
|
|
17
|
Arif SH, Mohammed AA. Abdomen cocoon causing chronic abdominal pain and intestinal obstruction; a case series. Ann Med Surg (Lond) 2019; 48:7-10. [PMID: 31692629 PMCID: PMC6806387 DOI: 10.1016/j.amsu.2019.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/30/2019] [Accepted: 10/06/2019] [Indexed: 01/20/2023] Open
Abstract
Abdomen cocoon is a rare disease in which a thick peritoneal membrane wraps the intestine causing the bowel loops to adhere to each other. It may be either primary(idiopathic) or secondary to other causes like previous abdominal surgery. Most patients present with abdominal pain and intestinal obstruction. The condition is usually diagnosed intraoperatively. Case 1 A 30-year-old male patient presented with abdominal pain and bilious vomiting. The patient had similar previous attacks. Examination showed distension abdominal distension with central tenderness. Plain abdominal X-ray showed multiple air fluid levels. During surgery most of ileum was enclosed by thin membrane with dilated proximal jejunum. Release of the bowel loops was done. The patient was well after surgery and was discharged with no post-operative complications. Case 2 A 35-year old male presented with chronic right lower quadrant abdominal pain, the past medical and surgical histories were non-relevant. Abdominal examination showed tenderness on deep palpation at the right iliac fossa, abdominal ultrasound and abdominal X-ray were normal. During diagnostic laparoscopy the terminal ileum was enclosed with a thick whitish membrane with dilated proximal ileum. Release of the adhesions was done. The patient was well in the post-operative period and he was discharged home with no post-operative complications. In both cases the biopsy from the membranes showed features of chronic inflammatory process. Abdomen cocoon is one of the rare causes of small bowel obstruction. The bowel adhesions should be opened and nonviable segments resected. Most patients have good long term outcome.
Abdomen cocoon is a rare disease in which a thick membrane wraps the intestine. It is either primary(idiopathic) or secondary to previous abdominal surgery. Most patients present with abdominal pain and intestinal obstruction which is usually diagnosed intraoperatively.
Collapse
Affiliation(s)
- Sardar Hassan Arif
- Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq
| | - Ayad Ahmad Mohammed
- Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq
| |
Collapse
|
|
18
|
Banday M, Rauof S. Secondary encapsulating peritonitis: a study of cases over five years. Turk J Surg 2019; 35:171-177. [PMID: 32550324 PMCID: PMC6795221 DOI: 10.5578/turkjsurg.4143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/24/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Cocoon abdomen or sclerosing encapsulating peritonitis is a rare condition characterized by bowel entrapment in a cocoon-like membrane. Primary and secondary types have been described. Most patients present acutely with intestinal obstruction or peritonitis but history of long standing chronic symptoms may be present. The condition is usually not detected on imaging, and diagnosis at laparotomy is common. Surgical treatment includes excision of the membrane with adhesiolysis. MATERIAL AND METHODS A 5-year study of the patients operated for cocoon abdomen in our hospital was conducted. Analysis of patient symptoms, imaging findings, intra-operative findings and histopathology was carried out. RESULTS Five males and three females were included into the study. Mean age was 29.6 years. Five patients presented with acute intestinal obstruction and three patients with perforation peritonitis. Laparotomy was performed in all cases. Successful excision of the membrane was done in all patients of obstruction while membrane excision could only be done in one patient of peritonitis. Histopathology revealed tuberculosis in six patients, one patient was already on anti-tubercular treatment and one patient had carcinoma. There was one mortality. CONCLUSION Cocoon abdomen is a rare condition. Tuberculosis should always be considered as a cause in endemic areas. Surgery is the preferred treatment and involves excision of the membrane but can be difficult in patients with superadded peritonitis or malignancy.
Collapse
Affiliation(s)
- Mansoor Banday
- Department of General Surgery, Esi Postgraduate Institute of Medical Sciences and Research and Hospital, Basaidarapur, New Delhi, India
| | - Sehrish Rauof
- Department of Nephrology, Government Medical College, Srinagar, India
| |
Collapse
|
|
19
|
Garg N, Sindwani G, Arora MK, Pamecha V. Living donor liver transplantation in a patient with cocoon abdomen - Anesthesia concerns! Saudi J Anaesth 2019; 13:75-77. [PMID: 30692895 PMCID: PMC6329246 DOI: 10.4103/sja.sja_655_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cocoon abdomen is a rare condition in which abdominal structures are surrounded by thick encapsulating peritoneum resulting in dense adhesions. Liver transplant is a high risk surgery with an already increased risk of massive blood loss due to the pre-existing coagulopathy and portal hypertension. Presence of cocoon abdomen with severe dense adhesions can either lead to difficult hepatectomy with massive intra-operative blood loss or failure to proceed with the surgery. This becomes even more important in live donor liver transplantation where it may not be possible to abandon the surgery once the donor liver resection is started. Thus keeping a high suspicion of cocoon abdomen in patients with previous history of kochs abdomen and on long term beta blocker therapy is of utmost importance and this can decrease the morbidity and mortality associated with this condition. A 41 year old male known case of chronic liver disease was posted for live donor liver transplantation. After opening the abdomen thick dense adhesions were found around the intestines and the liver. Due to the dense adhesions surgical team was in dilemma whether to proceed further for the surgery or not. Intra-operatively patient had a blood loss of 12.5 litre. Despite massive transfusion the postoperative course went uneventful and the patient was extubated on 2nd post-operative day. He was shifted out of Intensive care unit on the 6th post-operative day. Cocoon abdomen should be suspected in a chronic liver disease patient with previous history of tuberculosis or on long term beta blocker therapy. Proper preparation before surgery can decrease the morbidity and mortality associated with this major surgery. Our case report clearly shows that such types of patients can be taken up for the live donor liver transplantation surgery with a precaution to start donor hepatectomy only after surgeon has assessed the difficulty status of recipient hepatectomy.
Collapse
Affiliation(s)
- Neha Garg
- Department of Anesthesia, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Gaurav Sindwani
- Department of Anesthesia, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Mahesh Kumar Arora
- Department of Anesthesia, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vinyendra Pamecha
- Department of HPB and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India
| |
Collapse
|
|
20
|
Beckman RM, Stevens KA, Jones C. Chronic Bowel Obstruction in a Middle-aged Man. JAMA Surg 2019; 154:83-84. [PMID: 30140932 DOI: 10.1001/jamasurg.2018.2582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ross M Beckman
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kent A Stevens
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christian Jones
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
|
21
|
McMahon J, Dave A, Zahid A, Austin K. Peritoneal encapsulation as a cause of chronic recurrent abdominal pain in a young male. J Surg Case Rep 2018; 2018:rjy033. [PMID: 29593863 PMCID: PMC5841372 DOI: 10.1093/jscr/rjy033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 02/15/2018] [Indexed: 12/15/2022] Open
Abstract
This case report describes an otherwise well 20-year-old male who presented to hospital with vague, long-standing abdominal symptoms and was found to have peritoneal encapsulation.
Collapse
Affiliation(s)
- James McMahon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Aneesh Dave
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Assad Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Kirk Austin
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| |
Collapse
|
|
22
|
Sharma V, Singh H, Mandavdhare HS. Tubercular Abdominal Cocoon: Systematic Review of an Uncommon Form of Tuberculosis. Surg Infect (Larchmt) 2017; 18:736-741. [PMID: 28759335 DOI: 10.1089/sur.2017.110] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology and General Surgery, Postgraduate Institute of Medical Education and Research, India
| | - Harjeet Singh
- Department of Gastroenterology and General Surgery, Postgraduate Institute of Medical Education and Research, India
| | - Harshal S. Mandavdhare
- Department of Gastroenterology and General Surgery, Postgraduate Institute of Medical Education and Research, India
| |
Collapse
|
|
23
|
Intestinal Obstruction in a Patient with Sclerosing Encapsulating Peritonitis. Case Rep Surg 2017; 2017:8316147. [PMID: 28458941 PMCID: PMC5385222 DOI: 10.1155/2017/8316147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 03/06/2017] [Accepted: 03/19/2017] [Indexed: 01/01/2023] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare disorder that is characterized by encapsulation of bowel loops by thick fibrinogenous case. Most patients present with vague abdominal symptoms. It is challenging to diagnose the condition preoperatively. Surgical management is preserved for patients with small bowel obstruction with no improvement on conservative measures or for those with signs of bowel ischemia (Li et al., 2014; Habib et al. 2011). Herein, we discuss the clinical signs and symptoms, the radiological features, the surgical management, and outcome of SEP based on a patient who underwent surgery in our hospital.
Collapse
|
|
24
|
Sharma V, Mandavdhare HS, Rana SS, Singh H, Kumar A, Gupta R. Role of conservative management in tubercular abdominal cocoon: a case series. Infection 2017; 45:601-606. [PMID: 28341896 DOI: 10.1007/s15010-017-1012-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sclerosing encapsulating peritonitis (Abdominal cocoon) is an uncommon cause of intestinal obstruction and tuberculosis is an important etiology. Appropriate management of this entity is still uncertain. METHODS We did a retrospective analysis of patients with abdominal cocoon who were seen over a two year period at a tertiary care center in North India. We included patients with tubercular abdominal cocoon (TAC) who were managed primarily with antitubercular therapy in the present report. The diagnosis of TAC was made using combination of criteria (radiological or surgical findings of cocoon with evidence of tuberculosis in form of microbiological, histological or biochemical evidence). The clinical presentation, outcome and need for surgery for these patients were retrieved from the records of these cases maintained in a database. RESULTS Of 18 patients with abdominal cocoon, 15 patients had underlying tuberculosis. The median age was 28 years (interquartile range 24) and 12 (80%) were males. Three patients had confirmed tuberculosis on basis of microbiological evidence. All had abdominal pain for 1-9 months, and 11 had intestinal obstruction. Twelve patients had positive Mantoux test, none had HIV. Pulmonary tuberculosis was noted in four patients, pleural in five, splenic and intestinal in two each, hepatic and mediastinal lymph-nodal in one each. Thirteen patients were started on usual 4-drug anti-tubercular therapy (ATT) while two cirrhotics needed modified ATT. Three patients were on steroids with ATT and all three improved. One patient was lost to follow up. Of the rest 14 patients, 2 underwent surgery, 1 at initial presentation while another after 4 months of ATT. Overall five patients developed intestinal obstruction while on ATT, one needed surgery and one died of liver failure while others improved with conservative means. CONCLUSION TAC can be managed conservatively in a subset of patients.
Collapse
Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Harshal S Mandavdhare
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Kumar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Gupta
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
|
25
|
Casal Beloy I, García Novoa MA, Rivas Polo JI, Gómez Gutiérrez M. Cocoon syndrome with hepatic involvement. Incidental finding during orthotopic liver transplantation. Cir Esp 2016; 95:485-486. [PMID: 27863690 DOI: 10.1016/j.ciresp.2016.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 07/25/2016] [Accepted: 07/29/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Isabel Casal Beloy
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario A Coruña, A Coruña, España.
| | - María Alejandra García Novoa
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - Jose Ignacio Rivas Polo
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - Manuel Gómez Gutiérrez
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| |
Collapse
|
|
26
|
Machado NO. Sclerosing Encapsulating Peritonitis: Review. Sultan Qaboos Univ Med J 2016; 16:e142-51. [PMID: 27226904 DOI: 10.18295/squmj.2016.16.02.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/11/2016] [Accepted: 02/25/2016] [Indexed: 12/12/2022] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare chronic inflammatory condition of the peritoneum with an unknown aetiology. Also known as abdominal cocoon, the condition occurs when loops of the bowel are encased within the peritoneal cavity by a membrane, leading to intestinal obstruction. Due to its rarity and non-specific clinical features, it is often misdiagnosed. The condition presents with recurrent episodes of small bowel obstruction and can be idiopathic or secondary; the latter is associated with predisposing factors such as peritoneal dialysis or abdominal tuberculosis. In the early stages, patients can be managed conservatively; however, surgical intervention is necessary for those with advanced stage intestinal obstruction. A literature review revealed 118 cases of SEP; the mean age of these patients was 39 years and 68.0% were male. The predominant presentation was abdominal pain (72.0%), distension (44.9%) or a mass (30.5%). Almost all of the patients underwent surgical excision (99.2%) without postoperative complications (88.1%).
Collapse
Affiliation(s)
- Norman O Machado
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| |
Collapse
|
|
27
|
Yang CS, Kim D. Unusual intestinal obstruction due to idiopathic sclerosing encapsulating peritonitis: a report of two cases and a review. Ann Surg Treat Res 2016; 90:231-4. [PMID: 27073795 PMCID: PMC4826987 DOI: 10.4174/astr.2016.90.4.231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 01/26/2016] [Accepted: 02/15/2016] [Indexed: 02/08/2023] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction that is characterized by a thick fibrotic membrane encasing the small intestine like a cocoon. Accurate preoperative diagnosis is often difficult. We present 2 cases of SEP that were diagnosed preoperatively by contrast-enhanced computed tomography scan. A 38-year-old man and a 56-year-old woman were admitted to Daegu Catholic University Medical Center because of recurrent intestinal obstruction. We performed exploratory laparotomy with doubt of the preoperative diagnosis of SEP. We confirmed the diagnosis of SEP on laparotomy and performed adhesiolysis. Both patients recovered successfully and had no signs of recurrence. A better awareness of SEP and its radiological features should lead to more correct preoperative diagnosis and result in more appropriate management, including surgery.
Collapse
Affiliation(s)
- Chun-Seok Yang
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Daedong Kim
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| |
Collapse
|
|
28
|
Yavuz R, Akbulut S, Babur M, Demircan F. Intestinal Obstruction Due to Idiopathic Sclerosing Encapsulating Peritonitis: A Case Report. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e21934. [PMID: 26082852 PMCID: PMC4464369 DOI: 10.5812/ircmj.17(5)2015.21934] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 03/23/2015] [Accepted: 04/11/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Sclerosing encapsulating peritonitis (SEP) is characterized by partial or complete encasement of small intestine by a thick fibrocollagenous membrane. Depending on underlying causes, SEP is divided into primary and secondary forms. Idiopathic SEP is also called idiopathic or abdominal cocoon syndrome. Herein we presented a case of idiopathic SEP. CASE PRESENTATION A 90-year-old male patient presented to our emergency department with signs and symptoms of intestinal obstruction and dehydration. Physical examination findings, patient's age and plain abdominal radiography were consistent with tumoral obstruction or viscus perforation. Explorative laparotomy revealed a fibrous capsule encasing intestines as well as dense adhesions between intestinal loops. Since the overall condition of the patient was not well enough to allow a wide dissection and membrane excision, the operation was terminated after performing a limited loop ileostomy. Unfortunately, the patient was lost due to organ failure at the postoperative period. CONCLUSIONS Despite advances in radiological techniques, the exact diagnosis in many cases is still made according to intraoperative findings and histopathological properties of the excised membrane. While some cases of SEP remain asymptomatic for years, most cases are characterized by recurrent bouts of acute, subacute or chronic intestinal obstruction. To our knowledge, the case presented here is the oldest patient with idiopathic SEP in the literature.
Collapse
Affiliation(s)
- Ridvan Yavuz
- Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
| | - Sami Akbulut
- Department of Surgery, Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
- Corresponding Author: Sami Akbulut, Department of Surgery, Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey. Tel: +90-4223410660, Fax: +90-4223410036, E-mail:
| | - Mehmet Babur
- Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
| | - Firat Demircan
- Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
| |
Collapse
|
|
29
|
Akbulut S. Accurate definition and management of idiopathic sclerosing encapsulating peritonitis. World J Gastroenterol 2015; 21:675-87. [PMID: 25593498 PMCID: PMC4292304 DOI: 10.3748/wjg.v21.i2.675] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/20/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
AIM To review the literature on idiopathic sclerosing encapsulating peritonitis (SEP), also known as abdominal cocoon syndrome. METHODS The PubMed, MEDLINE, Google Scholar, and Google databases were searched using specific key words to identify articles related to idiopathic SEP. These key words were "sclerosing encapsulating peritonitis," "idiopathic sclerosing encapsulating peritonitis," "abdominal cocoon," and "abdominal cocoon syndrome." The search included letters to the editor, case reports, review articles, original articles, and meeting presentations published in the English-language literature from January 2000 to May 2014. Articles or abstracts containing adequate information about age, sex, symptom duration, initial diagnosis, radiological tools, and surgical approaches were included in the study. Papers with missing or inadequate data were excluded. RESULTS The literature search yielded 73 articles on idiopathic (primary) SEP published in 23 countries. The four countries that published the greatest number of articles were India (n = 21), Turkey (n = 14), China (n = 8) and Nigeria (n = 3). The four countries that reported the greatest number of cases were China (n = 104; 53.88%), India (n = 35; 18.13%), Turkey (n = 17; 8.80%) and Nigeria (n = 5; 2.59%). The present study included 193 patients. Data on age could be obtained for 184 patients (range: 7-87 years; mean ± SD, 34.7 ± 19.2 years), but were unavailable for nine patients. Of the 184 patients, 122 were male and 62 were female; sex data could not be accessed in the remaining nine patients. Of the 149 patients whose preoperative diagnosis information could be obtained, 65 (43.6%) underwent operations for abdominal cocoon, while the majority of the remaining patients underwent operations for a presumed diagnosis of intestinal obstruction and/or abdominal mass. Management information could be retrieved for 115 patients. Of these, 68 underwent excision + adhesiolysis (one laparoscopic); 24 underwent prophylactic appendectomy in addition to excision + adhesiolysis. Twenty patients underwent various resection and repair techniques along with excision + adhesiolysis. The remaining three patients were managed with antituberculosis therapy (n = 2) and immunosuppressive therapy (n = 1). CONCLUSION Idiopathic SEP is a rare disorder characterized by frequently recurring bouts of intestinal obstruction. Surgical therapy is the gold standard management strategy.
Collapse
|
|
30
|
Uzunoglu Y, Altintoprak F, Yalkin O, Gunduz Y, Cakmak G, Ozkan OV, Celebi F. Rare etiology of mechanical intestinal obstruction: Abdominal cocoon syndrome. World J Clin Cases 2014; 2:728-731. [PMID: 25405199 PMCID: PMC4233426 DOI: 10.12998/wjcc.v2.i11.728] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/07/2014] [Accepted: 08/31/2014] [Indexed: 02/05/2023] Open
Abstract
Abdominal cocoon syndrome is a rare cause of intestinal obstruction with unknown etiology. Diagnosis of this syndrome, which can be summarized as the small intestine being surrounded by a fibrous capsule not containing the mesothelium, is difficult in the preoperative period. A 47-year-old male patient was referred to the emergency department with complaints of abdominal pain, nausea, and vomiting for two days. The abdominal computed tomography examination detected dilated small intestinal loops containing air-fluid levels clustered in the left upper quadrant of the abdomen and surrounded by a thick, saclike, contrast-enhanced membrane. During exploratory surgery, a capsular structure was identified in the upper left quadrant with a regular surface that was solid-fibrous in nature. Abdominal cocoon syndrome is a rarely seen condition, for which the preoperative diagnosis is difficult. The combination of physical examination and radiological signs, and the knowledge of “recurrent characteristics of the complaints” that can be learned by a careful history, may be helpful in diagnosis.
Collapse
|
|
31
|
Stewart D, Rampersad R, King SK. Peritoneal encapsulation as a cause for recurrent abdominal pain in a 16-year-old male. ANZ J Surg 2014; 87:414-415. [PMID: 25387831 DOI: 10.1111/ans.12907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- David Stewart
- Department of Paediatric and Neonatal Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Rajay Rampersad
- Department of Paediatric and Neonatal Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sebastian K King
- Department of Paediatric and Neonatal Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgical Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| |
Collapse
|
|
32
|
Cağlar M, Cetinkaya N, Ozgü E, Güngör T. Persistent ascites due to sclerosing encapsulating peritonitis mimicking ovarian carcinoma: A case report. J Turk Ger Gynecol Assoc 2014; 15:201-3. [PMID: 25317050 DOI: 10.5152/jtgga.2014.37268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 11/02/2013] [Indexed: 12/28/2022] Open
Abstract
Sclerosing encapsulating peritonitis, also known as 'Cocoon Syndrome', is a rare cause of bowel obstruction. The condition might be congenital or acquired and has non-specific symptomatology. Abdominal pain occurs due to the limitation of intestinal motility or segment obstruction by a thick homogenous fibrotic mantle covering the intra-peritoneal organs. Altered peritoneal fluid dynamics result in persistent ascites. Leading pathogenic theories are not well defined, but genetic factors, retrograde trans-tubal flow of causative agents, peritoneal infections, medications and peritoneal invasive procedures are all thought to play a role. There are no specific diagnostic criteria and exact diagnosis is only confirmed during surgery when the investing thick fibrous folds covering the bowel loops are visualised. We present here a case that had been suspected to have an ovarian malignancy due to a huge abdominal heterogeneous mass and ascites on preoperative diagnostic workup, but had a final diagnosis of abdominal Cocoon Syndrome made during surgery.
Collapse
Affiliation(s)
- Mete Cağlar
- Department of Obstetrics and Gynecology, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Nilüfer Cetinkaya
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Emre Ozgü
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Tayfun Güngör
- Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| |
Collapse
|
|
33
|
Akbulut S, Yagmur Y, Babur M. Coexistence of abdominal cocoon, intestinal perforation and incarcerated Meckel’s diverticulum in an inguinal hernia: A troublesome condition. World J Gastrointest Surg 2014; 6:51-54. [PMID: 24672651 PMCID: PMC3964416 DOI: 10.4240/wjgs.v6.i3.51] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/05/2014] [Accepted: 02/18/2014] [Indexed: 02/06/2023] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare disease entity, in which the small intestine becomes encased and mechanically obstructed by a dense, fibrotic membrane. The disorder is characterized as either primary (idiopathic) or secondary to other causes. The idiopathic cases of SEP, which lack any identifiable etiology according to clinical, radiological and histopathological findings, are also reported under the designation of abdominal cocoon syndrome. The most frequent presenting symptoms of all SEP cases are nausea, vomiting, abdominal distention and inability to defecate, all of which are associated with the underlying intestinal obstruction. Persistent untreated SEP may advance to intestinal perforation, representing a life-threatening condition. However, preoperative diagnosis remains a particular clinical challenge, and most diagnoses are confirmed only when the typical fibrous membrane encasing the small intestine is discovered by laparotomy. Here, we report the clinical presentation of an 87-year-old male with signs of intestinal obstruction and the ultimate diagnosis of concurrent abdominal cocoon, right incarcerated Meckel’s diverticulum, and gastrointestinal perforation in laparotomy.
Collapse
|