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Zou Y, Xie X, Zhong C, Liu L, Wang Q, Yan S, Zou X, Liu Q. Case report: Robot-assisted laparoscopic partial nephrectomy for renal cell carcinoma in a patient with situs inversus totalis and abdominal cocoon. Front Surg 2023; 10:1095591. [PMID: 36874454 PMCID: PMC9981961 DOI: 10.3389/fsurg.2023.1095591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/24/2023] [Indexed: 02/19/2023] Open
Abstract
Background Situs inversus totalis (SIT) is a congenital condition wherein organs in abdominal or thoracic cavity are mirrored from their normal positions. Abdominal cocoon, is a rare disease of unknown aetiology that is characterised by total or partial small intestine encapsulation by a compact fibrocollagenous membrane. Aside from having two extremely rare conditions (SIT and Abdominal cocoon), our patient developed renal cell carcinoma (RCC), which makes this case even more uncommon. Case Presentation We report the case of a 64-year-old man who was admitted to our hospital with an extremely rare case of localized RCC in the left kidney complicated with SIT and abdominal cocoon. Computer tomography urography (CTU) and angiography (CTA) showed that the patient was confirmed as having SIT, for the space-occupying lesion in the left kidney, clear cell RCC (ccRCC) was considered, the lesion in the right kidney was probably cystic. We diagnosed our patient as having a cT1aN0M0 left RCC, and the RENAL score was 7x. With partial nephrectomy (PN) being the preferred treatment approach, robot-assisted laparoscopic partial nephrectomy (RALPN) was performed after obtaining informed consent. After insertion of the laparoscope, adhesions were observed between the entire colon and the anterior abdominal wall. Then, abdominal cocoon was diagnosed. The surgery was uneventful, and the tumour was resected successfully while preserving the tumour capsule. No intestinal injury or any other complication occurred in the intraoperative or postoperative, and the patient recovered well after the operation. Conclusion PN is an extremely challenging procedure in patients with SIT and abdominal cocoon. The da Vinci Xi surgical system and thorough preoperative assessment allowed the surgeon to overcome stereotyping, visual inversion, and successfully perform PN in a patient with SIT and abdominal cocoon without increasing the risk of complications and preserving as much renal function as possible. Considering the satisfactory outcomes, this report may hopefully provide a practical reference for the treatment of RCC in patients with other special conditions.
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Affiliation(s)
- Yuhua Zou
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Xiaojuan Xie
- Department of Cardiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Cunzhi Zhong
- Department of Anesthesiology, Operation Rom, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Li Liu
- Department of Anesthesiology, Operation Rom, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Qinlin Wang
- Department of Anesthesiology, Operation Rom, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Sheng Yan
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Xiaofeng Zou
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Quanliang Liu
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
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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] [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
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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] [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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SINGAL RIKKI, SATYASHREE B, MITTAL AMIT, SHARMA BHANUPRATAP, SINGAL SAMITA, ZAMAN MUZZAFARR, SHARDHA PARTEEK. Tubercular abdominal cocoon in children - a single centre study in remote area of northern India. CLUJUL MEDICAL (1957) 2017; 90:179-184. [PMID: 28559702 PMCID: PMC5433570 DOI: 10.15386/cjmed-725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/02/2016] [Accepted: 11/08/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Amongst the numerous causes of intestinal obstruction listed in the literature, sclerosing encapsulating peritonitis also called Abdominal Cocoon (AC) is one of the rarest entities. Its characteristic feature is a thick fibrotic membrane encasing varying lengths of the small and large gut in a cocoon. In India, there is an increasing incidence of tuberculosis, especially in the rural areas. AIMS AND OBJECTIVES The aim of this study was to investigate the clinical presentation and evaluate the operative findings of tuberculous AC. We also evaluated the outcomes and response to anti tuberculous treatment (ATT) in all the patients diagnosed with this condition. MATERIAL AND METHODS This study was carried out at M.M. Institute of Medical Sciences and Research, Mullana, Ambala, India between April 2013 - March 2016 in the Department of Pediatric Surgery. This is a prospective study. A total of 17 patients diagnosed with abdominal cocoon secondary to tuberculosis have been included in the study. RESULTS A total of 17 patients presented to the emergency ward with features of acute intestinal obstruction. The average age was 15.3 years (range 9 years to 16 years). There were 14 females and 3 males. All patients presented with abdominal pain, bilious vomiting, constipation and abdominal distention. The patients were operated in our hospital and relieved of their obstruction. Based on their operative findings and after histopathological confirmation, patients were given ATT. In the follow-up, all patients did well, without recurrence of tuberculosis or intestinal obstruction. CONCLUSION Tuberculosis as a cause of childhood AC is rather common in developing countries and is potentially a fatal condition. A strong clinical suspicion, sonographic and computed tomography scan findings help establish a pre-operative diagnosis. Tuberculous AC has a strong prevalence in females. Surgery is the mainstay of treatment followed by anti-tuberculous drugs.
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Affiliation(s)
- RIKKI SINGAL
- Department of Surgery - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
- Address for correspondence:
| | - B SATYASHREE
- Department of Pediatric Surgery - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
| | - AMIT MITTAL
- Department of Radiodiagnosis and Imaging - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
| | - BHANU PRATAP SHARMA
- Department of Surgery - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
| | - SAMITA SINGAL
- Department of Radiodiagnosis and Imaging - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
| | - MUZZAFARR ZAMAN
- Department of Surgery - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
| | - PARTEEK SHARDHA
- Department of Surgery - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
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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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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.
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Warner B, Davies B, Joshi D, Cairns S, Austin M. An unusual cause of vomiting. Clin Med (Lond) 2013; 13:522-3. [PMID: 24115717 PMCID: PMC4953811 DOI: 10.7861/clinmedicine.13-5-522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ben Warner
- Department of Gastroenterology, Digestive Diseases Centre, Royal Sussex County Hospital, Brighton, UK
| | - Beth Davies
- Department of Gastroenterology, Digestive Diseases Centre, Royal Sussex County Hospital, Brighton, UK
| | - Deepak Joshi
- Department of Gastroenterology, Digestive Diseases Centre, Royal Sussex County Hospital, Brighton, UK
| | - Stuart Cairns
- Department of Gastroenterology, Digestive Diseases Centre, Royal Sussex County Hospital, Brighton, UK
| | - Mark Austin
- Department of Gastroenterology, Digestive Diseases Centre, Royal Sussex County Hospital, Brighton, UK
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Hu D, Wang R, Xiong T, Zhang HW. Successful delivery after IVF-ET in an abdominal cocoon patient: case report and literature review. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2013; 6:994-997. [PMID: 23638238 PMCID: PMC3638117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 03/23/2013] [Indexed: 06/02/2023]
Abstract
Abdominal cocoon (AC) is a rare condition of uncertain etiology. We report the case of a 29-year-old infertile Chinese woman with AC, who successfully got twin pregnancy and delivery through in vitro fertilization (IVF) and embryo transfer (ET). And this review discusses the current concepts of its pathogenesis, diagnosis and treatments. AC might lead to tubal infertility and IVF-ET would be the most effective remedy for the patients desiring pregnancy.
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Affiliation(s)
- Dan Hu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, The People's Republic of China
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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: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [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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A rare cause of small bowel obstruction: Abdominal cocoon. Int J Surg Case Rep 2012; 3:272-4. [PMID: 22522743 DOI: 10.1016/j.ijscr.2012.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 03/19/2012] [Accepted: 03/20/2012] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The clinical manifestations of abdominal 'cocoon' are non-specific and hence its diagnosis is rarely made preoperatively and the management is often delayed. Surgery remains the main stay of treatment with satisfactory outcome and comprises excision of the fibrous membrane, meticulous adhesionolysis and release of the entrapped small bowel. PRESENTATION OF CASE A 45-year-old male patient presented with 6-month history of progressive subacute small bowel obstruction. After initial radiological investigations, he underwent diagnostic laparoscopy and was misdiagnosed as abdominal tuberculosis. He was started on anti-tuberculous therapy, but exploratory laparotomy was carried out after failure to respond to anti-tuberculous therapy. At laparotomy, the abdominal 'cocoon' which was encapsulating the entire small bowel was excised, and the adhesions were carefully lysed. The patient remained well and without recurrence at 1-year follow-up. DISCUSSION Abdominal 'cocoon' is a rare cause of subacute, acute and chronic small bowel obstruction. Its diagnosis is rarely made preoperatively. CONCLUSION Abdominal 'cocoon' should be thought of as a rare cause of small bowel obstruction. It may be mistaken with abdominal tuberculosis. Surgery remains the mainstay of curative treatment.
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