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Sudden and unexpected deaths due to non-traumatic abdominal disorders: A forensic perspective. J Forensic Leg Med 2022; 89:102355. [PMID: 35512523 DOI: 10.1016/j.jflm.2022.102355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/08/2022] [Accepted: 04/23/2022] [Indexed: 12/22/2022]
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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.
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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
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Gopireddy DR, Soule E, Arif-Tiwari H, Sharma S, Kanmaniraja D, Jain K, Letter H, Lall C. Spectrum of CT Findings Related to Bowel Adhesions Without Bowel Obstruction: A Comprehensive Imaging Review. J Clin Imaging Sci 2020; 10:80. [PMID: 33365202 PMCID: PMC7749936 DOI: 10.25259/jcis_126_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/24/2020] [Indexed: 11/05/2022] Open
Abstract
Post-operative adhesions can occur following abdominal or pelvic surgery and are a significant cause of morbidity and mortality. Adhesions are an important cause of abdominal complaints, especially chronic abdominal pain, infertility, and bowel obstruction; responsible for an estimated $2.3 billion annual burden in the United States alone. There is a paucity of literature describing CT findings indicative of the presence of adhesions, however, findings suggestive of this entity may be discovered by a discerning eye. Early recognition and diagnosis may be beneficial for reducing consumption of health-care resources related to abdominal complaints. In addition, these findings may impact surgical planning and facilitate recognition of adhesion-related complications, said to be responsible for a significant number of malpractice claims. The following review discusses various CT findings which may indicate the presence of adhesions. These findings may initially be overlooked, but remain valuable as the clinical presentation evolves to become consistent with adhesive disease. Detection of bowel and peritoneal adhesions can be recognized on imaging modalities based on distortion of bowel loops. This pictorial review illustrates the spectrum of findings related to bowel adhesions encountered on computed tomography imaging.
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Affiliation(s)
- Dheeraj Reddy Gopireddy
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
| | - Erik Soule
- Department of Interventional Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
| | - Hina Arif-Tiwari
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Smita Sharma
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
| | - Devaraju Kanmaniraja
- Department of Radiology, Montefiore Medical Center, Bronx, New York, United States
| | - Kapila Jain
- Department of Radiology, East and North Hertfordshire NHS Trust, Coreys Mill Lane, United Kingdom
| | - Haley Letter
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, Florida, United States
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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.
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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
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Renko AE, Witte SR, Cooper AB. Abdominal cocoon syndrome: an obstructive adhesiolytic metamorphosis. BMJ Case Rep 2019; 12:12/4/e228593. [PMID: 30975778 DOI: 10.1136/bcr-2018-228593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Abdominal cocoon syndrome (ACS), also known as idiopathic sclerosing peritonitis and primary sclerosing peritonitis, is a rare condition causing small bowel obstruction first described in 1978 by Foo et al It is characterised by total or partial encasement of the small bowel in a fibrocollagenous cocoon-like sac accompanied by extensive intrinsic small bowel adhesions. While the aetiology of this condition remains largely unknown, ACS can be divided into two subtypes: primary or idiopathic, which is often accompanied by cryptorchidism, and secondary to another cause such as congenital dysplasia or medications. Definitive diagnosis can only be achieved following laparotomy with extensive lysis of adhesions to alleviate the obstruction. However, preoperative diagnosis is possible if clinicians are aware of the condition and its radiologic signs.
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Affiliation(s)
- Abagayle E Renko
- The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - Samantha R Witte
- Department of Surgery, Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Amanda B Cooper
- Department of Surgery, Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
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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.
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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
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Singhal M, Krishna S, Lal A, Narayanasamy S, Bal A, Yadav TD, Kochhar R, Sinha SK, Khandelwal N, Sheikh AM. Encapsulating Peritoneal Sclerosis: The Abdominal Cocoon. Radiographics 2018; 39:62-77. [PMID: 30526331 DOI: 10.1148/rg.2019180108] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare but serious condition that results in (a) encapsulation of bowel within a thickened fibrocollagenous peritoneal membrane and (b) recurrent episodes of bowel obstruction. Although described by various names in the literature, the preferred term is encapsulating peritoneal sclerosis because it best describes the morphologic and histologic changes in this disorder. The etiology of EPS is multifactorial, with a wide variety of implicated predisposing factors that disrupt the normal physiologic function of the peritoneal membrane-prime among these factors being long-term peritoneal dialysis and bacterial peritoneal infections, especially tuberculosis. The clinical features of EPS are usually nonspecific, and knowledge of the radiologic features is necessary to make a specific diagnosis. The findings on radiographs are usually normal. Images from small-bowel follow-through studies show the bowel loops conglomerated in a concertina-like fashion with a serpentine arrangement in a fixed U-shaped configuration. US demonstrates a "cauliflower" appearance of bowel with a narrow base, as well as a "trilaminar" appearance depicted especially with use of high-resolution US probes. CT is the imaging modality of choice and allows identification of the thickened contrast material-enhanced abnormal peritoneal membrane and the encapsulated clumped bowel loops. In addition, CT can potentially help identify the cause of EPS (omental granuloma in tuberculosis), as well as the complications of EPS (bowel obstruction). Conservative medical treatment and surgical therapy early in the course of EPS have been used for management of the condition. The purpose of this article is to review the nomenclature and etiopathogenesis of EPS, describe the multimodality imaging appearances of EPS, including differentiating its features from those of other conditions mimicking EPS, and give an overview of management options. Online DICOM image stacks are available for this article. ©RSNA, 2018.
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Affiliation(s)
- Manphool Singhal
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| | - Satheesh Krishna
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| | - Anupam Lal
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| | - Sabarish Narayanasamy
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| | - Amanjit Bal
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| | - Thakur D Yadav
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| | - Rakesh Kochhar
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| | - Saroj K Sinha
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| | - Niranjan Khandelwal
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
| | - Adnan M Sheikh
- From the Departments of Radiology (M.S., A.L., N.K.), Histopathology (A.B.), General Surgery (T.D.Y.), and Gastroenterology (R.K., S.K.S.), PGIMER, Chandigarh, India; and the Abdominal Imaging Section, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ont, Canada (S.K., S.N., A.M.S.)
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Pattnaik SA, Mitra S, Mishra TS, Purkait S, Kumar P, Naik S. A Vasculitis-Associated Neuromuscular and Vascular Hamartoma Presenting as a Fatal Form of Abdominal Cocoon. Int J Surg Pathol 2018; 27:108-115. [PMID: 29992844 DOI: 10.1177/1066896918786582] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Neuromuscular and vascular hamartoma (NMVH), also known as neuromesenchymal hamartoma, is a rare hamartomatous condition of the intestine. It usually presents with submucosal humps protruding in the intestinal lumen causing obstructive features. The other clinical manifestations are hematochezia or melena and protein-losing enteropathy. The etiopathogenesis of these lesions is not well known, although an association with small bowel Cröhn's disease and diaphragm disease had been postulated, the latter related to chronic nonsteroidal anti-inflammatory drug intake. Only 24 cases of NMVH are reported in the English literature and all of them could be adequately cured by resection of the affected part of the bowel. Moreover, none of these cases presented with abdominal cocoon or showed any evidence of vasculitis. We describe a peculiar case of NMVH in a 45-year-old male who presented with abdominal cocoon with symptomatic recurrence and fatal outcome within a month of surgery. Histopathology revealed classical histomorphology of NMVH with evidence of vasculitis. This appears to be the first case of a fatal form of NMVH, presenting with abdominal cocoon and associated with vasculitis.
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Affiliation(s)
| | - Suvradeep Mitra
- 1 All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Suvendu Purkait
- 1 All India Institute of Medical Sciences, Bhubaneswar, India
| | - Pankaj Kumar
- 1 All India Institute of Medical Sciences, Bhubaneswar, India
| | - Suprava Naik
- 1 All India Institute of Medical Sciences, Bhubaneswar, India
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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] [MESH Headings] [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.
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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
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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] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Abdominal cocoon formation is an uncommon manifestation of abdominal tuberculosis that is characterized by the formation of a fibrous membrane-like sac around the small intestinal loops. Appropriate treatment and outcomes are uncertain Objectives: To review the clinical presentation, treatment, and outcomes for tubercular abdominal cocoon (TAC). PATIENTS AND METHODS We included studies published in the English language and listed in EMBASE or PubMed. All case series or reports that reported patients with TAC were considered for inclusion. Details regarding demographic, clinical presentation, and treatment received were tabulated. RESULTS The clinical features included predominantly abdominal pain, abdominal distension and features of intestinal obstruction, loss of appetite, and weight loss. The diagnosis was usually established at surgery, however, computed tomography was a useful tool. In most patients the treatment reported was surgical, however, conservative therapy with anti-tubercular therapy (ATT) did succeed in a subset of patients. The published literature includes only case series and reports. The outcomes, especially long-term outcomes, have not been reported in most studies. CONCLUSION Abdominal cocoon is an uncommon form of abdominal tuberculosis and conservative management with ATT may suffice in some patients whereas non-responsive cases require surgery.
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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
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Jagdale A, Prasla S, Mittal S. Abdominal cocoon - A rare etiology of intestinal obstruction. J Family Med Prim Care 2017; 6:674-676. [PMID: 29417033 PMCID: PMC5787980 DOI: 10.4103/2249-4863.222040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Abdominal cocoon is one of the rare causes of intestinal obstruction. It is referred as complete or partial small bowel encapsulation caused by the thick fibrocollagenous membrane. It is most common in young adolescent girls. We present a 40-year-old male patient with idiopathic abdominal cocoon. Few cases of male patients suffering from idiopathic abdominal cocoon have been reported in literature.
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Affiliation(s)
- Amol Jagdale
- Department of Radiodiagnosis, Dr. Vasantrao Pawar Medical College and Research Center, Nashik, Maharashtra, India
| | - Shopnil Prasla
- Department of Radiodiagnosis, Dr. Vasantrao Pawar Medical College and Research Center, Nashik, Maharashtra, India
| | - Saurav Mittal
- Department of Radiodiagnosis, Dr. Vasantrao Pawar Medical College and Research Center, Nashik, Maharashtra, India
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12
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Acar T, Kokulu İ, Acar N, Tavusbay C, Hacıyanlı M. Idiopathic encapsulating sclerosing peritonitis. ULUSAL CERRAHI DERGISI 2015; 31:241-3. [PMID: 26668535 DOI: 10.5152/ucd.2015.2786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/05/2014] [Indexed: 12/28/2022]
Abstract
Sclerosing encapsulating peritonitis (SEP)/abdominal cocoon syndrome is a rare condition that is generally identified in young females. The exact cause is still unknown. Timely and accurate imaging and diagnosis play a critical role for morbidity and mortality. It is usually diagnosed during surgery. The initial treatment should be conservative, and aggressive surgical approach should be avoided as much as possible. Herein, we aimed to review the clinical features of SEP based on a patient who underwent surgery in our clinic.
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Affiliation(s)
- Turan Acar
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - İbrahim Kokulu
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Nihan Acar
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Cengiz Tavusbay
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Mehmet Hacıyanlı
- Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
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13
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Multiple abdominal cocoons: an unusual presentation of intestinal obstruction and a diagnostic dilemma. Case Rep Surg 2015; 2015:282368. [PMID: 25893128 PMCID: PMC4393895 DOI: 10.1155/2015/282368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 03/09/2015] [Accepted: 03/09/2015] [Indexed: 12/21/2022] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) or abdominal cocoon is a rare acquired condition with an unknown aetiology. It is characterized by encapsulation of the small bowel by a fibrous membrane and can lead to intestinal obstruction. We present the case of a 42-year-old gentleman with a history of hepatitis C, tuberculosis, and previous abdominal surgery, who presented with subacute intestinal obstruction. Surgical exploration of the abdomen revealed that the entire contents were enclosed into three distinct sacs by a dense fibrous membrane. Excision of the sacs was performed followed by adhesiolysis. This is believed to be the first reported case of multiple cocoons within the abdominal cavity. The case is discussed with reference to the literature.
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Abstract
BACKGROUND Intestinal obstruction remains a common problem encountered in the surgical emergency, and usually occurs secondary to adhesions, obstructed herniae or tubercular strictures. However, at times, rare causes of obstruction can also be encountered. METHODS A 24-year-old male patient presented with recurrent episodes of intestinal obstruction that was found to be secondary to an abdominal cocoon on laparotomy. RESULTS The patient underwent adhesiolysis of the cocoon, and remains well on a follow-up. Histopathological report of the cocoon wall revealed fibrocollagenic tissues with a mixed inflammatory infiltrate, without any evidence of tuberculosis. CONCLUSIONS Abdominal cocoon can be a rare cause of intestinal obstruction in male patients. Adhesiolysis of the cocoon membrane releases the obstruction and gives good results.
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Affiliation(s)
- Mayank Jayant
- Department of Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Robin Kaushik
- Department of Surgery, Government Medical College and Hospital, Chandigarh, India
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Abstract
BACKGROUND Intestinal obstruction remains a common problem encountered in the surgical emergency, and usually occurs secondary to adhesions, obstructed herniae or tubercular strictures. However, at times, rare causes of obstruction can also be encountered. METHODS A 24-year-old male patient presented with recurrent episodes of intestinal obstruction that was found to be secondary to an abdominal cocoon on laparotomy. RESULTS The patient underwent adhesiolysis of the cocoon, and remains well on a follow-up. Histopathological report of the cocoon wall revealed fibrocollagenic tissues with a mixed inflammatory infiltrate, without any evidence of tuberculosis. CONCLUSIONS Abdominal cocoon can be a rare cause of intestinal obstruction in male patients. Adhesiolysis of the cocoon membrane releases the obstruction and gives good results.
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Affiliation(s)
- Mayank Jayant
- Department of Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Robin Kaushik
- Department of Surgery, Government Medical College and Hospital, Chandigarh, India
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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: 19] [Impact Index Per Article: 1.7] [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.
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Abdominal cocoon syndrome (idiopathic sclerosing encapsulating peritonitis): how easy is its diagnosis preoperatively? A case report. Case Rep Surg 2013; 2013:604061. [PMID: 23738183 PMCID: PMC3662120 DOI: 10.1155/2013/604061] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 04/07/2013] [Indexed: 12/16/2022] Open
Abstract
The abdominal cocoon syndrome (or idiopathic encapsulating peritonitis) is a rare cause of intestinal obstruction. It has been reported predominantly in adolescent girls living in tropical/subtropical region in which diagnosis is only made at laparotomy in most cases. The cause and pathogenesis of the condition have not been elucidated. Prolonged administration of practalol, meconium peritonitis, and tuberculous infection of the female genital tract have been incriminated as possible causes. The author reports a case of a female patient with recurrent intestinal obstruction treated for years but failed to settle down on conservative treatment during her last hospital admission and had to undergo surgery. Preoperative diagnosis of this syndrome as the cause of her intestinal obstruction was not made until at laparotomy, when a thick fibrotic peritoneal wrapping of the bowel in a concertina-like fashion with some adhesions was found. Excision of this membrane and adhesiolysis were carried out without any need for bowel resection, and this led to relief of the obstruction and patient's complete recovery. Awareness of this benign condition in the differential diagnosis of intestinal obstruction will result in early diagnosis and correct management and prevent unnecessary bowel resections and bad outcomes.
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Abdominal cocoon syndrome (idiopathic sclerosing encapsulating peritonitis): how easy is its diagnosis preoperatively? A case report. Case Rep Surg 2013. [PMID: 23738183 DOI: 10.1155/2013/6040619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The abdominal cocoon syndrome (or idiopathic encapsulating peritonitis) is a rare cause of intestinal obstruction. It has been reported predominantly in adolescent girls living in tropical/subtropical region in which diagnosis is only made at laparotomy in most cases. The cause and pathogenesis of the condition have not been elucidated. Prolonged administration of practalol, meconium peritonitis, and tuberculous infection of the female genital tract have been incriminated as possible causes. The author reports a case of a female patient with recurrent intestinal obstruction treated for years but failed to settle down on conservative treatment during her last hospital admission and had to undergo surgery. Preoperative diagnosis of this syndrome as the cause of her intestinal obstruction was not made until at laparotomy, when a thick fibrotic peritoneal wrapping of the bowel in a concertina-like fashion with some adhesions was found. Excision of this membrane and adhesiolysis were carried out without any need for bowel resection, and this led to relief of the obstruction and patient's complete recovery. Awareness of this benign condition in the differential diagnosis of intestinal obstruction will result in early diagnosis and correct management and prevent unnecessary bowel resections and bad outcomes.
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19
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Tannoury JN, Abboud BN. Idiopathic sclerosing encapsulating peritonitis: abdominal cocoon. World J Gastroenterol 2012; 18:1999-2004. [PMID: 22563185 PMCID: PMC3342596 DOI: 10.3748/wjg.v18.i17.1999] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 02/20/2012] [Accepted: 02/26/2012] [Indexed: 02/06/2023] Open
Abstract
Abdominal cocoon, the idiopathic form of sclerosing encapsulating peritonitis, is a rare condition of unknown etiology that results in an intestinal obstruction due to total or partial encapsulation of the small bowel by a fibrocollagenous membrane. Preoperative diagnosis requires a high index of clinical suspicion. The early clinical features are nonspecific, are often not recognized and it is difficult to make a definite pre-operative diagnosis. Clinical suspicion may be generated by the recurrent episodes of small intestinal obstruction combined with relevant imaging findings and lack of other plausible etiologies. The radiological diagnosis of abdominal cocoon may now be confidently made on computed tomography scan. Surgery is important in the management of this disease. Careful dissection and excision of the thick sac with the release of the small intestine leads to complete recovery in the vast majority of cases.
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Abstract
Abdominal tuberculosis in children usually presents with involvement of the peritoneum, lymph nodes or gastro-intestinal tract. Disease of the gastro-intestinal tract is commonest in the ileocaecal region. A 10-year-old girl presented with abdominal pain and fever of 15 days duration. Abdominal CT detected dilated small bowel loops with enlarged mesenteric nodes and barium meal follow-through demonstrated a small annular stricture in the jejunum, suggestive of jejunal tuberculosis. She was treated with anti-tuberculous chemotherapy and corticosteroids, to which she made a good response. Tuberculosis of the jejunum is rare in children.
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Affiliation(s)
- Ramya Uppuluri
- Pediatric TB Clinic, B. J. Wadia Hospital for Children, Mumbai, India
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