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1
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Abera MT, Abdela AF, Adela AY, Annose RT, Kebede AG. Sclerosing encapsulating peritonitis: A rare cause of intestinal obstruction in 2 patients. Radiol Case Rep 2024; 19:2477-2482. [PMID: 38577128 PMCID: PMC10992281 DOI: 10.1016/j.radcr.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/06/2024] [Accepted: 03/09/2024] [Indexed: 04/06/2024] Open
Abstract
Sclerosing encapsulating peritonitis is a very rare cause of intestinal obstruction. It usually follows peritoneal dialysis. The idiopathic form is also called abdominal cocoon and is more common in tropical and subtropical regions. We hereby present the clinical histories and imaging findings of 2 confirmed cases of sclerosing encapsulating peritonitis who presented with chronic symptoms of bowel obstruction.
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Affiliation(s)
| | - Abubeker Fedlu Abdela
- Department of Radiology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Rodas Temesgen Annose
- Department of Radiology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Assefa Getachew Kebede
- Department of Radiology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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2
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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.
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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
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3
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Mishra S, Chaudhary K, Tyagi S, Mishra P, Misra V. Primary sclerosing encapsulating peritonitis. INDIAN J PATHOL MICR 2024; 67:182-184. [PMID: 38358217 DOI: 10.4103/ijpm.ijpm_1228_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Sclerosing encapsulating peritonitis also known as cocoon abdomen is a rare chronic inflammatory condition of the peritoneum in which the bowel loops are encircled by a membrane (cocoon formation) within the peritoneal cavity leading to intestinal obstruction. It can be primary (idiopathic) or secondary (chemotherapy, beta-blockers, peritoneal dialysis, shunts, tuberculosis, systemic lupus erythematosus, etc.). The symptomatology report includes recurrent episodes of abdominal pain and vomiting. We present here a case of a 32-year-old male who presented with complaints of being unable to pass stools, vomiting (3-4 times), and abdomen pain for 4 days. This case is considered worth mentioning due to its rarity, lack of identification of secondary causes, and diminutive mention of histopathological aspect.
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Affiliation(s)
- Swati Mishra
- Department of Pathology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Kuldeep Chaudhary
- Department of Pathology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Swati Tyagi
- Department of Pathology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Pratibha Mishra
- Department of Surgery, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | - Vatsala Misra
- Department of Pathology, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
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4
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Nabata K, Watanabe A, Stuart H. Sclerosing encapsulating peritonitis causing fatal bowel obstruction. BMJ Case Rep 2023; 16:e255625. [PMID: 37923337 PMCID: PMC10626900 DOI: 10.1136/bcr-2023-255625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare condition characterised by a fibrotic peritoneal membrane encasing loops of bowel often resulting in obstruction. We present a case of SEP complicated by non-resolving small bowel obstruction in the context of prior malignancies and surgical complications. A literature review on SEP was performed to outline potential aetiologies, diagnostic investigations and treatment strategies that may be considered in the management of this disease.
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Affiliation(s)
- Kylie Nabata
- General Surgery, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Akie Watanabe
- General Surgery, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Heather Stuart
- General Surgery, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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5
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Melki G, Mohamed A, Alkomos MF, Farokhian A, Chaudhry SM, Patel V, Baddoura WJ. Encapsulating peritoneal sclerosis in liver transplant. Autops Case Rep 2021; 11:e2021272. [PMID: 34307228 PMCID: PMC8214905 DOI: 10.4322/acr.2021.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/24/2021] [Indexed: 11/23/2022]
Abstract
Encapsulating peritoneal sclerosis occurs due to chronic irritation of the peritoneal surface resulting in inflammation and fibrosis. Encapsulating peritoneal sclerosis usually occurs in patients requiring peritoneal dialysis (PD); however, it may also occur in liver transplant patients. The fibrosis in encapsulating peritoneal sclerosis could be severe enough to cause small bowel obstruction (SBO). Herein, we report a case of encapsulating peritoneal sclerosis secondary to liver transplantation that presented with SBO. The patient was started on Tamoxifen for encapsulating peritoneal sclerosis and evaluated at follow-up without any other intestinal obstruction episodes. This case demonstrates that encapsulating peritoneal sclerosis can occur as a liver transplant complication and present with small bowel obstruction.
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Affiliation(s)
- Gabriel Melki
- St. Joseph's University Medical Center, Department of Internal Medicine, Paterson, NJ, USA
| | - Abdalla Mohamed
- St. Joseph's University Medical Center, Department of Gastroenterology and Hepatology, Paterson, NJ, USA
| | - Mina Fransawy Alkomos
- St. Joseph's University Medical Center, Department of Internal Medicine, Paterson, NJ, USA
| | - Alisa Farokhian
- St. Joseph's University Medical Center, Department of Internal Medicine, Paterson, NJ, USA
| | - Sohail M Chaudhry
- St. Joseph's University Medical Center, Department of Internal Medicine, Paterson, NJ, USA
| | - Varun Patel
- St. Joseph's University Medical Center, Department of Gastroenterology and Hepatology, Paterson, NJ, USA
| | - Walid J Baddoura
- St. Joseph's University Medical Center, Department of Gastroenterology and Hepatology, Paterson, NJ, USA
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6
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Fieren MW, Betjes MG, Korte MR, Boer WH. Posttransplant Encapsulating Peritoneal Sclerosis: A Worrying New Trend? Perit Dial Int 2020. [DOI: 10.1177/089686080702700603] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication in patients on peritoneal dialysis (PD). We describe a cluster of 13 EPS cases occurring in 2 university hospitals in The Netherlands. Most of these cases were diagnosed after recent kidney transplantation, when the patients developed severe symptoms of bowel obstruction. This accumulation raised the question as to whether other than known risk factors, such as duration of PD treatment, could be involved in the development or course of EPS after transplantation. According to various publications, EPS has been diagnosed often after withdrawal from PD, suggesting that cessation in itself may be a risk factor. In addition, transplantation-related management should be considered to play a role, including the use of the profibrotic calcineurin inhibitors and the trend to reduce the load of corticosteroids in treatment regimes. To identify risk factors, further multicenter studies are required, paying special attention to alterations in immunosuppressive treatment regimens as well as PD prescriptions, including PD fluid characteristics. Transfer from PD to hemodialysis should be under serious consideration in patients eligible for kidney transplantation as soon as there are indications of ultrafiltration failure.
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Affiliation(s)
| | - Michiel G.H. Betjes
- Nephrology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam
| | - Mario R. Korte
- Nephrology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam
| | - Walther H. Boer
- Department of Nephrology, University Medical Center, Utrecht, The Netherlands
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7
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López Grove R, Heredia Martínez A, Aineseder M, de Paula J, Ocantos J. Sclerosing encapsulating peritonitis: Imaging findings in an uncommon entity. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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8
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López Grove R, Heredia Martínez A, Aineseder M, de Paula JA, Ocantos JA. Sclerosing encapsulating peritonitis: imaging findings in an uncommon entity. RADIOLOGIA 2019; 61:388-395. [PMID: 30987740 DOI: 10.1016/j.rx.2019.02.005] [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] [Received: 09/19/2018] [Revised: 02/06/2019] [Accepted: 02/24/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To describe the most characteristic imaging findings for sclerosing encapsulating peritonitis, with an emphasis on the computed tomography findings. CONCLUSION The incidence of sclerosing encapsulating peritonitis is low. The pathophysiology of this condition is unclear. Two types are recognized: idiopathic and secondary; the secondary type is generally a complication of peritoneal dialysis. Its nonspecific clinical presentation and the absence of blood markers mean that sclerosing encapsulating peritonitis is usually diagnosed late. Thus, it is important to know the imaging signs; these include thickening and calcification of the peritoneum and dilation of bowel loops with thickening and calcification of bowel walls, whether in isolation or in association with loculated ascites. Although ultrasonography allows the complexity of the collections to be evaluated, computed tomography is the most useful technique for the general assessment of the signs mentioned above.
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Affiliation(s)
- R López Grove
- Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - A Heredia Martínez
- Servicio de Nefrología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - M Aineseder
- Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - J A de Paula
- Servicio de Gastroenterología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - J A Ocantos
- Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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9
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Aliyev V, Yagi S, Hammad A, Badawy A, Sasaki Y, Masano Y, Yamamoto G, Kamo N, Taura K, Okajima H, Kaido T, Uemoto S. Sclerosing encapsulating peritonitis after living-donor liver transplantation: A case series, Kyoto experience. Ann Hepatobiliary Pancreat Surg 2018; 22:144-149. [PMID: 29896575 PMCID: PMC5981144 DOI: 10.14701/ahbps.2018.22.2.144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 11/17/2022] Open
Abstract
Sclerosing encapsulating peritonitis (SEP), or abdominal cocoon is a rare cause of intestinal obstruction, and still etiology remains unknown. We report a series of 4 patients with abdominal cocoon, and all the 4 patients had previously undergone living-donor liver transplantation (LDLT). There was no evidence of SEP before and during LDLT. At the time of diagnosis of SEP, 3 out of 4 patients had ascites. First and fourth patients had multiple episodes or attacks of cholangitis, which were managed by percutaneous transhepatic biliary drainage and hepaticojejunostomy, respectively. All 4 patients presented with intestinal obstruction and 3 of them underwent a successful operation. The fourth patient died due to liver failure and complications of the SEP. The first 3 patients are doing well without SEP recurrence. Our experience suggest that the prognosis of SEP is poor in patients with poor graft liver functions after LDLT.
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Affiliation(s)
- Vusal Aliyev
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shintaro Yagi
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ahmed Hammad
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of General Surgery, Mansoura University, Mansoura, Egypt
| | - Amr Badawy
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Surgery, Alexandria University, Alexandria, Egypt
| | - Yudai Sasaki
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuki Masano
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Gen Yamamoto
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoko Kamo
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kojiro Taura
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hideaki Okajima
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshimi Kaido
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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10
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Blajin A, Cristian D, Sălcianu I, Welt L, Scăunaşu RV, Berevoescu N, Blajin C, Burcoş T. The diagnostic and therapeutic management of a peculiar case of rectal submucosal adenocarcinoma. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2018. [DOI: 10.25083/2559.5555/31.4752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction. We are presenting the case of a 50 years old female patient with rectal cancer, developed from the submucosal level, who raised difficulties in diagnoses process and therapeutic management. Case report. The patient’s symptomatology began four months before the definitive diagnose. Various investigations have been performed, including multiple biopsies which were inconclusive. Surgical intervention was performed to obtain definitive malignancy HP result. The postoperative evolution was peculiar, marked by complications, which required multiple surgical interventions. Conclusions. The development of the adenoma, predominantly at the submucosal and muscular level has caused difficulties in both establishing the diagnosis and in the therapeutic management. Sclerosing encapsulated peritonitis (SEP) is a rare clinical entity, usually discovered in postoperative intestinal obstruction cases. The etiology and frequency of SEP depend on its’ type.
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11
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Kong YX, Strasser SI, McCaughan GW, Crawford M, Verran DJ. Sclerosing peritonitis post liver transplantation: a rare condition where surgery is an important treatment option. ANZ J Surg 2017; 88:E424-E428. [PMID: 28782907 DOI: 10.1111/ans.14128] [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: 01/07/2017] [Revised: 04/23/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sclerosing peritonitis (SP) is a rare but potentially fatal complication following orthotopic liver transplantation (OLT). The definitive surgical management is via a laparotomy peritonectomy and enterolysis procedure, but this carries risks particularly in the immunosuppressed transplant patient population. The natural history of SP is known from a handful of case reports and series, which mostly report de novo cases arising early on following OLT. The aim of this study was to identify all cases of de novo SP following OLT and the outcomes of management. METHODS Cases of SP post OLT were identified from the Australian National Liver Transplantation Unit (New South Wales) database of all 1393 adult patients. RESULTS Three cases of SP were diagnosed between 2 and over 9 years post-transplantation. Two patients proceeded to laparotomy and a peritonectomy and enterolysis procedure of the cocooned bowel. The third was managed conservatively due to a relatively indolent course and their medical co-morbidities. CONCLUSION SP should be considered in the differential diagnosis in patients post OLT presenting with symptoms of bowel obstruction, even years following transplantation. Surgery may be required in order to achieve a satisfactory outcome in some cases.
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Affiliation(s)
- Yvonne X Kong
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Simone I Strasser
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Geoffrey W McCaughan
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael Crawford
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Deborah J Verran
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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12
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Shah J, Kumar A, Singh H, Agarwala R, Sharma V, Rana SS. Cocoon carcinomatosa: An unusual cause of intestinal obstruction. Drug Discov Ther 2017; 11:51-53. [PMID: 28190800 DOI: 10.5582/ddt.2017.01003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abdominal cocoon, also termed sclerosing encapsulating peritonitis, is an uncommon entity associated with formation of a fibro-collagenous membrane around intestinal loops resulting in intestinal obstruction. Most reported cases are idiopathic, but many other causes have been implicated in cocoon formation, including use of continuous ambulatory peritoneal dialysis, peritoneal tuberculosis, and connective tissue disease. However, peritoneal carcinomatosis is a rarely reported entity that causes this condition. Reported here are two cases of abdominal cocoon secondary to peritoneal carcinomatosis. Both patients presented with intestinal obstruction; one underwent surgery but the other refused surgery.
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Affiliation(s)
- Jimil Shah
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research
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13
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Allam H, Al Yahri O, Mathew S, Darweesh A, Suliman AN, Abdelaziem S, Khairat M, Toro A, Di Carlo I. The enigma of primary and secondary encapsulating peritoneal sclerosis. BMC Surg 2016; 16:81. [PMID: 27964725 PMCID: PMC5153754 DOI: 10.1186/s12893-016-0198-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/30/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Encapsulating Peritoneal Sclerosis (EPS) describes a variety of diseases that are frequently confused with different names and different etiopathogeneses. The aim of this article is to report personal experience of focusing on correct classification and the status of current diagnosis and treatment. METHODS A retrospective analysis was performed. Age, sex, ethnic origin, past medical history, symptoms and their duration, radiological tools and signs, laboratory tests, preoperative diagnosis, surgical approach, intraoperative findings, pathological findings, hospital stay, morbidity and mortality were studied. RESULTS A total of seven patients, including six males and one female, aged from 24 to 72 years were observed. Four patients had recurrent abdominal colic pain for 3 months, 1, 2 and 9 years; two patients also reported recurrent attacks but without any specification of the duration. All seven patients presented at the emergency department with abdominal pain that was mainly diffused over the entire abdomen. Six patients were submitted to a CT scan. Only in two patients was the diagnosis of EPS made preoperatively. All seven patients were submitted to open surgery. The hospital stay was between 4 and 60 days. One patient had morbidity, and one patient died of MOF. CONCLUSIONS Currently, the correct identification of EPS is more easily possible than in the past, but the diagnosis is still a challenge. Surgery must be performed as soon as possible to avoid a poorer quality of life.
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Affiliation(s)
- Hisham Allam
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050 Doha, Qatar
| | - Omer Al Yahri
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050 Doha, Qatar
| | - Sharon Mathew
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050 Doha, Qatar
| | - Adham Darweesh
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Ahmed Nafea Suliman
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050 Doha, Qatar
| | - Sherif Abdelaziem
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050 Doha, Qatar
| | - Mohamed Khairat
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050 Doha, Qatar
| | - Adriana Toro
- Department of General Surgery, Barone I. Romeo Hospital, Patti, Messina Italy
| | - Isidoro Di Carlo
- Departments of General Surgery, Hamad General Hospital, Al Rayyan Road, 3050 Doha, Qatar
- Department of Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania, Italy
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14
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Noh SH, Ye BD, So H, Kim YS, Suh DJ, Yoon SN. Sclerosing encapsulating peritonitis in a long-term propranolol user. Intest Res 2016; 14:375-378. [PMID: 27799890 PMCID: PMC5083268 DOI: 10.5217/ir.2016.14.4.375] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 08/08/2015] [Accepted: 08/24/2015] [Indexed: 12/11/2022] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare cause of bowel obstruction that is characterized by the encasement of the small bowel by a thick, whitish, and fibrous membrane. The pathophysiology of SEP is poorly understood and preoperative diagnosis is difficult. Previous reports suggest that SEP may be linked to the chronic use of β-adrenergic blockers. A 46-year-old man with liver cirrhosis and end-stage renal disease on hemodialysis presented with recurrent abdominal pain and borborygmi. He had been taking propranolol to prevent bleeding from gastroesophageal varices for the past 15 years. Abdominal computed tomography showed ileal loops encapsulated by soft tissue with dilatation of the proximal small bowel on the right side of the abdomen. Barium follow-through showed conglomerated distal ileal loops with a cauliflower-like appearance. Explorative laparotomy revealed a thick, fibrous, whitish capsule encapsulating the ileal loops. The covering membrane was dissected and excised, resulting in an improvement in symptoms after surgery. Accordingly, a final diagnosis of SEP was made. Due to the lack of other apparent causes for SEP, we conclude that in this case, the long-term use of propranolol may be associated with the development of SEP.
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Affiliation(s)
- Se Hui Noh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.; Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hoonsub So
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu Seok Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Jin Suh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Nam Yoon
- Department of Colon & Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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15
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Idiopathic Sclerosing Encapsulating Peritonitis: A Rare Cause of Subacute Intestinal Obstruction. Case Rep Med 2016; 2016:8206894. [PMID: 27642301 PMCID: PMC5014933 DOI: 10.1155/2016/8206894] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 08/07/2016] [Indexed: 12/21/2022] Open
Abstract
We present a case of a previously healthy 50-year-old gentleman who had recurrent vomiting and abdominal pain of two-month duration. The patient was subsequently diagnosed with abdominal cocoon on computed tomography. Idiopathic sclerosing encapsulating peritonitis, also known as abdominal cocoon, is a rare cause of small bowel obstruction. Visualization of variable encasement of the small bowel loops by a characteristic membranous sac, either preoperatively with cross-sectional imaging or intraoperatively, is the key to diagnosis. This is a highly treatable condition; surgical excision of the sac with adhesiolysis facilitates a full recovery in affected patients.
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16
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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: 82] [Impact Index Per Article: 9.1] [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%).
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Affiliation(s)
- Norman O Machado
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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Surgical treatment and perioperative management of idiopathic abdominal cocoon: single-center review of 65 cases. World J Surg 2015; 38:1860-7. [PMID: 24519587 DOI: 10.1007/s00268-014-2458-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The abdominal cocoon (AC) is a condition in which a variable length of healthy small bowel is enveloped in a fibrocollagenous membrane, giving the appearance of a cocoon. Early experiences with treatment were associated with high mortality and morbidity rates and a low preoperative diagnostic rate, leading to underestimation of the treatment benefit of surgery. METHODS We retrospectively reviewed the medical records of 65 patients who were diagnosed as having AC from 2001 to 2011. The clinical data, surgical intervention, and perioperative management were carefully reviewed. RESULTS The 65 patients (57 male, 8 female) had a median age of 39 years (range 14-79 years). Patients who received preoperative nutritional support had higher rate of grade 0 complications (p = 0.012) and a lower rate of grade II complications (p = 0.012) than those without nutritional support. Intestinal stenting during surgical intervention also decreased both grade I (p = 0.012) and grade II (p = 0.007) complications. Patients who received preoperative nutritional support and underwent intestinal stenting had a lower rate of postoperative complications (p < 0.05). In addition, patients with preoperative nutritional support were more satisfied postoperatively (p = 0.018) than those without nutritional support. This was also observed in patients with intestinal stenting versus those without it (p = 0.027). CONCLUSIONS Our single-center study with a large number of patients provided evidence regarding the epidemiology of AC. Preoperative nutritional support and intestinal stenting significantly reduced postoperative complications and, more importantly, increased postoperative satisfaction.
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Rehman ZU. Cocoon abdomen - A rare cause of intestinal obstruction. Int J Surg Case Rep 2014; 11:95-97. [PMID: 25951614 PMCID: PMC4446657 DOI: 10.1016/j.ijscr.2014.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/13/2014] [Accepted: 08/30/2014] [Indexed: 11/29/2022] Open
Abstract
Sclerosing encapsulating peritonitis persistent low-grade peritonitis. Most cases are discovered incidentally on laparotomy. Computed tomography or barium meal may be helpful in preoperative diagnosis. Simple removal of the membrane and lysis of the adhesions produces optimal outcome. Bowel resection is indicated only when the intestine is nonviable. A high index of suspicion and appropriate radiology can prevent ‘surprises’ and unnecessary bowel resection. INTRODUCTION Sclerosing encapsulating peritonitis or abdominal cocoon is a rare condition of unknown etiology in which intestinal obstruction result from encasement of variable length of bowel by dense fibro collagenous membrane. PRESENTATION OF CASE A case of young male is reported who presented with features of small bowel obstruction with tender mass in the right iliac fossa. CT scan suggested features of internal herniation. On exploration, he was found to have small intestine, large intestine, stomach and liver covered with a thick cocoon like membrane. The membrane was gently peeled off the small intestine. The patient recovered well and was discharged on an oral diet. DISCUSSION Preoperative diagnosis of abdominal cocoon is difficult and most cases are discovered incidentally on laparotomy. Contrast enhanced computed tomography or barium meal may be helpful in preoperative diagnosis. Surgical treatment is the main stay of treatment for this condition. Simple removal of the membrane and lysis of the adhesions produces optimal outcome. Bowel resection is indicated only when the intestine is nonviable. CONCLUSION A high index of suspicion and appropriate radiology can prevent ‘surprises’ and unnecessary bowel resection. Simple removal of the membrane gives a good outcome.
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Affiliation(s)
- Zia Ur Rehman
- Department of Surgery, The Aga Khan University Hospital, Stadium Road, Karachi, Pakistan.
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Li M, Zhu W, Li Y, Jiang J, Li J, Li N. Long intestinal tube splinting prevents postoperative adhesive small-bowel obstruction in sclerosing encapsulating peritonitis. BMC Gastroenterol 2014; 14:180. [PMID: 25420530 PMCID: PMC4289301 DOI: 10.1186/1471-230x-14-180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 08/11/2014] [Indexed: 01/23/2023] Open
Abstract
Background Sclerosing encapsulating peritonitis (SEP) is a rare cause of small-bowel obstruction. The optimal treatment for this condition remains controversial. Methods In this study, we performed a retrospective analysis of the data of 44 patients who underwent surgery for SEP between December 2001 and 2008 at our hospital. The long-term follow-up data of the patients were assessed for the recurrence of adhesive small-bowel obstruction (ASBO), and patient survival was assessed to evaluate the efficiency of tube splinting in the prevention of postoperative ASBO. Results Of the 44 patients who underwent surgery for SEP, 33 underwent simple enterolysis along with tube splinting, while the remaining underwent only simple enterolysis. The median follow-up period was 79.4 ± 24.8 months (range: 8–123 months). The rate of complications was 9.1% and 6.1% in the simple enterolysis group and tube-splinting group, respectively (P = 0.73). The recurrence rate of ASBO was lower in the tube-splinting group (6.7%) than in the simple enterolysis group (40%) (P = 0.02). Conclusion Our findings indicate that tube splinting may be more useful than simple enterolysis alone in preventing the recurrence of ASBO in patients with SEP.
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Affiliation(s)
| | | | | | | | | | - Ning Li
- Department of General Surgery, Jinling Hospital, Medicine School of Nanjing University, NO 305 East Zhongshan Road, Nanjing, Jiangsu Province, China.
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Puppala R, Sripathi S, Kadavigere R, Koteshwar P, Singh J. Abdominal cocoon secondary to disseminated tuberculosis. BMJ Case Rep 2014; 2014:bcr-2013-202568. [PMID: 25239980 DOI: 10.1136/bcr-2013-202568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abdominal cocoon, also known as sclerosing encapsulating peritonitis, represents a rare entity where a variable length of the small bowel is enveloped by a fibrocollagenous membrane giving the appearance of a cocoon. It may be asymptomatic and is often diagnosed incidentally at laparotomy. We present a rare case of abdominal cocoon due to abdominal tuberculosis.
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Affiliation(s)
- Radha Puppala
- Department of Radiodiagnosis, Kasturba Medical College, Manipal, Karnataka, India
| | - Smiti Sripathi
- Department of Radiodiagnosis, Kasturba Medical College, Manipal, Karnataka, India
| | - Rajagopal Kadavigere
- Department of Radiodiagnosis, Kasturba Medical College, Manipal, Karnataka, India
| | - Prakashini Koteshwar
- Department of Radiodiagnosis, Kasturba Medical College, Manipal, Karnataka, India
| | - Jyoti Singh
- Malathi Manipal Hospital, Bangalore, Karnataka, India
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Al Ani AH, Al Zayani N, Najmeddine M, Jacob S, Nair S. Idiopathic sclerosing encapsulating peritonitis (abdominal cocoon) in adult male. A case report. Int J Surg Case Rep 2014; 5:735-8. [PMID: 25217877 PMCID: PMC4189066 DOI: 10.1016/j.ijscr.2014.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/19/2014] [Accepted: 07/21/2014] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Abdominal cocoon (sclerosing encapsulating peritonitis) (SEP) is a rare condition, mostly affecting adolescent girls living in tropical/subtropical region. Its etiology is unknown. It may cause acute or sub-acute intestinal obstruction. PRESENTATION OF CASE We report here a 39 year old male who complained of long standing colicky abdominal pain, with significant weight loss. Abdomen CT scan showed clumping of ileal loops at the level of umbilicus, with a thin capsule surrounding it. Laparoscopy revealed abdominal cocoon, biopsy of which showed dense hypocellular fibro-collagenous tissue with no neoplastic or granulomatous process. Excision of fibrous tissue and release of adhesions was done. Patient was symptoms free after five months follow up. DISCUSSION Abdominal exploration is usually needed for the diagnosis and treatment of abdominal cocoon. A thick fibrotic peritoneal wrapping of the bowel is usually found. Complete recovery is the result in majority of cases after surgical removal of the wrap causing the cocoon. CONCLUSION Primary sclerosing encapsulating peritonitis (cocoon abdomen) diagnosis needs a high index of suspicion, as signs and symptoms are nonspecific and imaging findings are not always conclusive. Careful excision of the accessory peritoneal sac and lysis of adhesions between bowels is the best treatment. Prognosis is generally good.
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Affiliation(s)
- Amer Hashim Al Ani
- Department of General Surgery, Bahrain Specialist Hospital, Manama, Bahrain.
| | - Najah Al Zayani
- Department of Gastroenterology and Hepatology, Bahrain Specialist Hospital, Manama, Bahrain
| | - Mohammad Najmeddine
- Department of Gastroenterology and Hepatology, Bahrain Specialist Hospital, Manama, Bahrain
| | - Sunitha Jacob
- Department of Pathology, Bahrain Specialist Hospital, Manama, Bahrain
| | - Sunil Nair
- Department of Diagnostic Radiology, Bahrain Specialist Hospital, Manama, Bahrain
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Al Ani AH, Al Zayani N, Najmeddine M, Jacob S, Nair S. Idiopathic sclerosing encapsulating peritonitis (abdominal cocoon) in adult male. A case report. Int J Surg Case Rep 2014. [PMID: 25217877 DOI: 10.1016/j.ijscr.2014.07.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Abdominal cocoon (sclerosing encapsulating peritonitis) (SEP) is a rare condition, mostly affecting adolescent girls living in tropical/subtropical region. Its etiology is unknown. It may cause acute or sub-acute intestinal obstruction. PRESENTATION OF CASE We report here a 39 year old male who complained of long standing colicky abdominal pain, with significant weight loss. Abdomen CT scan showed clumping of ileal loops at the level of umbilicus, with a thin capsule surrounding it. Laparoscopy revealed abdominal cocoon, biopsy of which showed dense hypocellular fibro-collagenous tissue with no neoplastic or granulomatous process. Excision of fibrous tissue and release of adhesions was done. Patient was symptoms free after five months follow up. DISCUSSION Abdominal exploration is usually needed for the diagnosis and treatment of abdominal cocoon. A thick fibrotic peritoneal wrapping of the bowel is usually found. Complete recovery is the result in majority of cases after surgical removal of the wrap causing the cocoon. CONCLUSION Primary sclerosing encapsulating peritonitis (cocoon abdomen) diagnosis needs a high index of suspicion, as signs and symptoms are nonspecific and imaging findings are not always conclusive. Careful excision of the accessory peritoneal sac and lysis of adhesions between bowels is the best treatment. Prognosis is generally good.
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Affiliation(s)
- Amer Hashim Al Ani
- Department of General Surgery, Bahrain Specialist Hospital, Manama, Bahrain.
| | - Najah Al Zayani
- Department of Gastroenterology and Hepatology, Bahrain Specialist Hospital, Manama, Bahrain
| | - Mohammad Najmeddine
- Department of Gastroenterology and Hepatology, Bahrain Specialist Hospital, Manama, Bahrain
| | - Sunitha Jacob
- Department of Pathology, Bahrain Specialist Hospital, Manama, Bahrain
| | - Sunil Nair
- Department of Diagnostic Radiology, Bahrain Specialist Hospital, Manama, Bahrain
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Rumbo C, Zambernardi A, Cabanne A, Rumbo M, Gondolesi G. Sclerosing peritonitis, a rare complication after intestinal transplant. Report of one case successfully treated with adjustment of immunosuppression. Pediatr Transplant 2013; 17:E125-9. [PMID: 23902605 DOI: 10.1111/petr.12110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2013] [Indexed: 01/01/2023]
Abstract
Sclerosing peritonitis is a complication described in different clinical situations, such as patients that underwent prolonged peritoneal dialysis or renal transplantation with previous history of peritoneal dialysis. The origin of this entity is unclear so far and it is believed that several mechanisms may contribute to its development. The hallmark of sclerosing peritonitis is the continuous accumulation of fibrocollagenous deposits in the intestinal wall and mesenteries causing progressive adhesion of the intestinal loops and mesenteric retraction resulting in intestinal obstruction. Also, it has been described as a rare complication after intestinal transplant that might lead to graft failure. In this report, we describe a case of sclerosing peritonitis after intestinal transplantation that was successfully treated with modifications in the immunosuppressive regime allowing restitution of gastrointestinal transit and intestinal autonomy.
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Affiliation(s)
- Carolina Rumbo
- Instituto de Trasplante Multiorgánico (ITMO), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.
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Sclerosing encapsulating peritonitis after living donor liver transplantation: a case successfully treated with tamoxifen: report of a case. Surg Today 2012; 43:1326-9. [PMID: 23099621 DOI: 10.1007/s00595-012-0368-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 05/17/2012] [Indexed: 01/29/2023]
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare cause of bowel obstruction. It is difficult to diagnose and the prognosis is poor. This report describes a case of SEP after living donor liver transplantation that was successfully treated with tamoxifen. A 56-year-old male, that had received a liver transplant for hepatitis C virus-related hepatocellular carcinoma 5 years earlier, was admitted with continuous abdominal pain and nausea. He had increased C-reactive protein levels and white blood cell count, and underwent laparotomy 5 days after hospitalization. The surgical findings showed ascites and SEP of the small bowel. An attempt to peel off the adhesions was stopped because there was a strong risk of intestinal tract damage. Tamoxifen treatment was initiated for SEP after surgery. The patient's symptoms gradually improved and he was able to resume feeding. He had been symptom-free for over 3 years at the last follow-up.
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Araújo JDAB, Martines JADS, Martines BMR, da Silva AF, Lovisolo SM, de Castro CC. Idiopathic sclerosing encapsulating peritonitis: an uncommon cause of intestinal obstruction. AUTOPSY AND CASE REPORTS 2012; 2:51-56. [PMID: 31528580 PMCID: PMC6735565 DOI: 10.4322/acr.2012.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 07/31/2012] [Indexed: 12/18/2022] Open
Abstract
Sclerosing encapsulating peritonitis (SEP), also called encapsulating peritonitis, is a rare and benign cause of intestinal obstruction of unknown etiology. Its onset may be acute or subacute although there are some reports with a two-month history. More commonly, this entity is secondary to chronic peritoneal dialysis, ventriculoperitoneal and peritoneovenous shunting, the use of β-blockers and systemic lupus erythematous. Recurrent episodes of bacterial peritonitis, intestinal tuberculosis, sarcoidosis, familial Mediterranean fever, gastrointestinal cancer, liver transplantation, intra-abdominal fibrogenic foreign bodies, and luteinized ovarian thecomas are also related to SEP. The idiopathic presentation is more rare. Abdominal pain, nausea, vomiting, weight loss, malnutrition, and clinically palpable mass characterize the clinical features. Diagnosis is frequently made with gross findings during surgery, imaging workup and histopathology. The authors report the case of a 36-year-old male patient with a 10-day history of abdominal pain that was operated on because of intestinal obstruction. Diagnosis was made preoperatively and confirmed by the intraoperative findings and histopathology.
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Affiliation(s)
| | | | | | - Adriano Ferreira da Silva
- Diagnostic Imaging Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Silvana Maria Lovisolo
- Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Cláudio Campi de Castro
- Diagnostic Imaging Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil.,Department of Radiology - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
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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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Sclerosing peritonitis: a rare but fatal complication of peritoneal inflammation. Mediators Inflamm 2012; 2012:709673. [PMID: 22619486 PMCID: PMC3349264 DOI: 10.1155/2012/709673] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 01/22/2012] [Indexed: 12/19/2022] Open
Abstract
Sclerosing peritonitis is a rare form of peritoneal inflammation with an often fatal outcome. The major risk factor of sclerosing peritonitis is peritoneal dialysis treatment but it can also occur following renal or liver transplantation or be associated with certain drug treatment. This article gives an overview of reasons and treatment options for sclerosing peritonitis and shows a summery of current literature about sclerosing peritonitis.
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Meshikhes AW, Bojal S. A rare cause of small bowel obstruction: Abdominal cocoon. Int J Surg Case Rep 2012; 3:272-274. [PMID: 22522743 PMCID: PMC3356543 DOI: 10.1016/j.ijscr.2012.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [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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Affiliation(s)
- Abdul-Wahed Meshikhes
- General Surgery Section, Department of Surgery, King Fahad Specialist Hospital, Dammam 31444, Saudi Arabia
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Huddam B, Azak A, Koçak G, Başaran M, Voyvoda N, Duranay M. Additive effectiveness of everolimus plus tamoxifen therapy in treatment of encapsulating peritoneal sclerosis. Ren Fail 2012; 34:387-9. [PMID: 22263915 DOI: 10.3109/0886022x.2011.647338] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Peritoneal dialysis (PD) is one of the commonly used choices of continuous renal replacement therapies. Peritoneal membrane is damaged by using solutions with lower biocompatibility, peritonitis episodes, and vintage of PD therapy. Encapsulating peritoneal sclerosis (EPS) is a rare complication of PD and is presented by progressive fibrosis of the peritoneum. Fibrous tissue entrapment of the intestine, leading to complete intestinal obstruction, is referred to as EPS, the most severe form of sclerosing peritonitis. EPS is irreversible fibrosis of the peritoneal membrane usually associated with high rates of morbidity and mortality. Preventive strategies are the best choice of treatment. Also there is no proven effective therapy for EPS; there are only small-sized trials. Herein we present a case of EPS who improved with everolimus plus tamoxifen therapy.
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Affiliation(s)
- Bülent Huddam
- Department of Nephrology, Ankara Education and Research Hospital, Ankara, Turkey
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30
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Da Luz MMP, Barral SM, Barral CM, Bechara CDS, Lacerda-Filho A. Idiopathic encapsulating peritonitis: report of two cases. Surg Today 2011; 41:1644-8. [PMID: 21969199 DOI: 10.1007/s00595-010-4493-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 12/26/2010] [Indexed: 12/18/2022]
Abstract
This report presents two cases of young males who developed the rare idiopathic form of sclerosing encapsulating peritonitis (SEP) presented as partial bowel obstruction, both diagnosed during surgical treatment, with satisfactory outcomes. Sclerosing encapsulating peritonitis is a rare and enigmatic condition, characterized by intraperitoneal fibrosclerosis, which causes intestinal obstruction. It is a chronic entity with a poorly elucidated pathophysiology, leading to the constitution of a thick white nacreous fibrosis membrane that wraps the bowel in a concertina-like fashion with some adhesions configuring an intra-abdominal cocoon. Sclerosing encapsulating peritonitis is reported in a wide variety of patients, including those who have undergone peritoneal dialysis, young adolescent girls, cirrhotic patients after peritoneal-venous shunting, and patients treated with β-blockers. Nevertheless, the etiology of SEP remains obscure. This entity presents many difficulties in preoperative diagnosis because of its peculiar characteristics. Recognition of the SEP results in proper management and prevents unnecessary bowel resection. Regardless of cause, the treatment of the obstruction is surgical, with dissection of the encasing membrane from the intestine and separation of adherent loops of small bowel until they are laid free and returned to their normal configuration. The prognosis after appropriate surgical therapy is good, but depends on coexisting diseases.
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Affiliation(s)
- Magda Maria Profeta Da Luz
- Division of Coloproctology and Small Bowel, Alfa Institute of Gastroenterology, Federal University of Minas Gerais Hospital, Av. Alfredo Balena 110 - 2° andar, Belo Horizonte, MG 30130-100, Brazil
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Faria B, Rodrigues A. Peritoneal dialysis in transplant recipient patients: outcomes and management. ACTA ACUST UNITED AC 2011; 45:444-51. [PMID: 21702728 DOI: 10.3109/00365599.2011.592857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Transplant recipient patients performing dialysis represent a growing population in the integrated model of renal replacement therapy. This includes both patients with kidney allograft loss and non-renal organ transplant recipients requiring dialysis. Although a number of possible advantages of peritoneal dialysis over haemodialysis could hypothetically favour its choice when starting dialysis, peritoneal dialysis penetration is relatively residual in this population. Questions about its safety and adequacy in these patients can explain this fact. The purpose of this review is to address unfounded fears and document evidence that peritoneal dialysis should be considered a viable and safe choice in patients returning to dialysis. Specific issues that still need further investigation are also discussed.
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Affiliation(s)
- Bernardo Faria
- Nephrology and Dialysis Unit, Hospital São Teotónio, Viseu, Portugal.
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Jaber S, Dulaijan K, Sadoun M, Moghazy K, El-Said M. Post-traumatic intra-cocoon mesenteric tear: a case report. Case Rep Gastroenterol 2011; 5:206-11. [PMID: 21552447 PMCID: PMC3088750 DOI: 10.1159/000326946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Sclerosing peritonitis, more commonly called abdominal cocoon, is a rare intra-peritoneal disease that is characterized by complete or partial encapsulation of the small intestine by a thick collagenous membrane. This disease mostly presents in the form of small bowel obstruction, however in our case the patient presented with intra-cocoon bleeding following a motor vehicle accident.
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Affiliation(s)
- Saed Jaber
- Department of Surgery, King Fahd Medical Military Complex, Dhahran, Saudi Arabia
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Perl J, Bargman JM, Jassal SV. Peritoneal dialysis after nonrenal solid organ transplantation: clinical outcomes and practical considerations. Perit Dial Int 2011; 30:7-12. [PMID: 20056972 DOI: 10.3747/pdi.2008.00215] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The incidence of end-stage renal disease following nonrenal solid organ transplantation (NRSOT) is increasing and is associated with a poor prognosis. The etiology of end-stage renal disease is multifactorial, with calcineurin inhibitor (CNI) nephrotoxicity being primarily responsible. The impact of dialysis modality on the survival of these patients remains unclear. Peritoneal dialysis appears to be a feasible and safe option for renal replacement therapy in NRSOT patients. Concerns that NRSOT patients are at a higher risk of infectious and noninfectious complications necessitate practical considerations when prescribing and planning for peritoneal dialysis in these patients. While nephrotoxicity is a well-recognized complication of long-term CNI use, "peritoneotoxic" effects with significant alterations in peritoneal membrane structure and function have recently been described. Further study including the role of CNI-free immunotherapy protocols to optimize the outcomes of NRSOT recipients is needed.
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Affiliation(s)
- Jeffrey Perl
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
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Kirshtein B, Mizrahi S, Sinelnikov I, Lantsberg L. Abdominal cocoon as a rare cause of small bowel obstruction in an elderly man: report of a case and review of the literature. Indian J Surg 2011; 73:73-75. [PMID: 22211046 PMCID: PMC3077183 DOI: 10.1007/s12262-010-0200-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2008] [Accepted: 02/17/2009] [Indexed: 12/18/2022] Open
Abstract
Abdominal cocoon is a rare cause of intestinal obstruction usually diagnosed incidentally at laparotomy. The cause and pathogenesis of the condition have not been elucidated. It primarily affects adolescent girls living in tropical and subtropical regions. Several earlier cases have been reported in males. We describe an 82-year-old man presenting with small bowel obstruction without history of previous abdominal surgery. He was treated by warfarin following aortic valve replacement. Abdominal cocoon was detected at laparotomy. Excision of membrane and lysis of adhesions led to relief of obstruction. Abdominal cocoon is a rare pathology that may be found in all kinds of populations. It may be a rare form of small bowel obstruction diagnosed during surgery in elderly patients.
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Affiliation(s)
- Boris Kirshtein
- Department of Surgery A, Soroka University Medical Center, Beer Sheva, Israel
| | - Solly Mizrahi
- Department of Surgery A, Soroka University Medical Center, Beer Sheva, Israel
| | - Igor Sinelnikov
- Department of Pathology, Soroka University Medical Center, Beer Sheva, Israel
| | - Leonid Lantsberg
- Department of Surgery A, Soroka University Medical Center, Beer Sheva, Israel
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IZAWA T, MURAI F, AKIYOSHI H, OHASHI F, YAMATE J, KUWAMURA M. Encapsulating Peritoneal Sclerosis Associated with Abnormal Liver Development in a Young Dog. J Vet Med Sci 2011; 73:697-700. [DOI: 10.1292/jvms.10-0503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Takeshi IZAWA
- Laboratory of Veterinary Pathology, Osaka Prefecture University
| | - Fumi MURAI
- Laboratory of Veterinary Pathology, Osaka Prefecture University
| | - Hideo AKIYOSHI
- Laboratory of Veterinary Surgery, Osaka Prefecture University
| | - Fumihito OHASHI
- Laboratory of Veterinary Surgery, Osaka Prefecture University
| | - Jyoji YAMATE
- Laboratory of Veterinary Pathology, Osaka Prefecture University
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Testa A, Baiocchini A, Comandini U, Falasca L, Nardacci R, Maritti M, Loiacono L, Bibbolino C, Rizzi E, Cristofaro M, Ettorre G, Vennarecci G, Antonucci G, Del Nonno F. Fatal Sclerosing Peritonitis Associated With Primary Effusion Lymphoma After Liver Transplantation: A Case Report. Transplant Proc 2010; 42:3849-53. [DOI: 10.1016/j.transproceed.2010.08.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 07/06/2010] [Accepted: 08/19/2010] [Indexed: 10/18/2022]
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Térébus Loock M, Lubrano J, Courivaud C, Bresson Vautrin C, Kastler B, Delabrousse E. CT in predicting abdominal cocoon in patients on peritoneal dialysis. Clin Radiol 2010; 65:924-9. [PMID: 20933648 DOI: 10.1016/j.crad.2010.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 06/03/2010] [Accepted: 06/10/2010] [Indexed: 12/12/2022]
Abstract
AIM To evaluate the computed tomography (CT) signs of encapsulating peritoneal sclerosis (EPS) in patients on peritoneal dialysis (PD) as predictive factors for the evolution to abdominal cocoon (AC). MATERIALS AND METHODS Clinical features and CT signs of 90 patients on PD were retrospectively reviewed. According to the clinical features, they were divided into three groups (asymptomatic, moderate, or severe). Clinical results were correlated with previously reported CT signs of EPS, i.e., peritoneal thickening, peritoneal calcifications, loculated fluids, small bowel faeces sign, small bowel obstruction, clustered bowel loops, pseudo sac, signs of bowel ischaemia or necrosis. AC was defined at CT by the association of clustered bowel loops and a pseudo sac. Statistical analysis was performed using the Fisher's exact test and the t-test. RESULTS Although demonstrated in symptomatic patients (p=0.041), the occurrence of AC was not correlated with the severity of the symptoms (p=0.16). Among the CT signs, the presence of loculated fluids (p=0.011), a small bowel faeces sign (p=0.002); and small bowel obstruction (p=0.0001) were found to be statistically correlated with the appearance of an AC. Moreover, the association of loculated fluids, small bowel faeces sign, small bowel obstruction was extremely sensitive and specific in the development of AC (sensitivity=67%, specifity=100%, positive predictive value=100%, negative predictive value=96%). CONCLUSION CT should be carried out in every symptomatic patient on PD. Indeed, the association of loculated fluid, small bowel faeces sign, and small bowel obstruction enables the prediction of the development of AC, which is likely to curtail PD and require surgery.
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Al Saied G, Hassan AZ, Ossip M, Hassan AZ. Idiopathic sclerosing encapsulating peritonitis. Case report and review of literature. Eur Surg 2010. [DOI: 10.1007/s10353-010-0506-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Mishra A, Mabrouk E, Ferjani A, Rishi M, Ebshina F, Ehtuish EF. A problem encapsulated - role of CT. Libyan J Med 2010; 5. [PMID: 21483584 PMCID: PMC3066765 DOI: 10.3402/ljm.v5i0.4901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 01/10/2010] [Indexed: 11/14/2022] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare but serious complication of abdominal surgery, recurrent peritonitis, and continuous ambulatory peritoneal dialysis with a high morbidity and mortality. The etiology of this condition is largely unknown. Diagnosis is usually established at laparotomy in patients with recurrent attacks of non-strangulating, small bowel obstruction. We report a case of a patient who presented with intestinal obstruction and who showed typical CT findings of SEP which was diagnosed pre-operatively on a CT scan and confirmed at surgery. The interest of this case lies in its rarity and difficult pre-operative diagnosis.
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Affiliation(s)
- Anuj Mishra
- Department of Radiology, National Organ Transplant Program, Central Hospital, Tripoli, Libya
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Abstract
OBJECTIVE abdominal cocoon is characterized by total or partial encasement of the small bowel by a thick fibrotic membrane, leading to mechanical obstruction. Here, we report two cases of abdominal cocoon; both patients presented with symptoms of intestinal obstruction. CONCLUSION We describe the CT and sonographic features of this disease, emphasizing the role of MDCT, and discuss the preoperative diagnostic clues.
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Kalra S, Atia A, McKinney J, Borthwick TR, Smalligan RD. Sclerosing encapsulating peritonitis associated with propranolol usage: a case report and review of the literature. J Dig Dis 2009; 10:332-5. [PMID: 19906115 DOI: 10.1111/j.1751-2980.2009.00405.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Sumit Kalra
- Department of Internal Medicine, James H. Quillen VA Medical Center, Johnson City, Mountain Home, Tennessee 37684, USA.
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Yamada S, Tanimoto A, Matsuki Y, Hisada Y, Sasaguri Y. Sclerosing encapsulating peritonitis (abdominal cocoon) associated with liver cirrhosis and diffuse large B-cell lymphoma: autopsy case. Pathol Int 2009; 59:681-6. [PMID: 19712139 DOI: 10.1111/j.1440-1827.2009.02427.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A case of sclerosing encapsulating peritonitis (SEP) associated with liver cirrhosis (LC) and complicated by diffuse large B-cell lymphoma (DLBCL) is reported herein. A 49-year-old Japanese man had undergone peritoneo-venous shunt against refractory ascites due to hepatitis C virus-positive uncompensated LC for 2 years. After he received a diagnosis of DLBCL of the left neck lymph node 3 months before his death, palliative care was given because of his poor general condition. He developed severe abdominal distention and pain over 1 week and was found to have marked ascites and whole bowel lumped together on abdominal CT. At autopsy, the peritoneum was covered with a thick white membrane and the bowel could not be distinguished, which was macroscopically characterized by a cocoon-like appearance. Histology indicated a proliferation of diffusely thickened or hyalinized fibrocollagenous tissue in the entire peritoneum with a slight chronic inflammatory infiltrate and without remarkable change of mucosa. A diagnosis of SEP, also known as abdominal cocoon, was established based on these features. Additionally, in the abdominal cavity, a large amount of serous ascites and multiple peritoneal nodules or masses involved by DLBCL were recognized. To the authors' knowledge this is the first case report of SEP associated with LC and complicated by the invasion of DLBCL in the abdominal cavity.
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Affiliation(s)
- Sohsuke Yamada
- Department of Pathology and Cell Biology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Abdominal cocoon: clinical presentation, diagnosis, and management. J Gastrointest Surg 2009; 13:1160-2. [PMID: 18649113 DOI: 10.1007/s11605-008-0595-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Accepted: 06/25/2008] [Indexed: 02/07/2023]
Abstract
A 15-year-old girl presented with features suggestive of sub-acute intestinal obstruction (SAIO) with a palpable abdominal lump. Contrast-enhanced computed tomogram (CECT) abdomen revealed congregated small gut loops confined to a single area and encased in a thick membrane suggestive of abdominal cocoon. On laparotomy, a thick white membrane was found encasing most of the small gut. The cocoon was excised releasing the encased small bowel. The patient was relieved of her symptoms following surgery. Histopathology of excised cocoon membrane revealed granulomatous inflammation consistent with tuberculosis. The patient was discharged on ninth postoperative day with advice to take anti-tuberculosis drugs for 6 months. The possibility of abdominal cocoon should be considered in patients with SAIO and abdominal lump. Abdominal cocoon being a rare condition, CECT is useful in clinching the diagnosis and planning elective surgery in experienced hands.
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Tagnaouti M, Branger B, Ied C, Reboul P, Zabadani B, Vecina F, Deschodt G, Carolfi J, Prudhomme M, Godlevski G. La sclérose péritonéale encapsulante : aspects actuels. Nephrol Ther 2009; 5:122-33. [DOI: 10.1016/j.nephro.2008.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 07/08/2008] [Accepted: 08/28/2008] [Indexed: 10/21/2022]
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Mekeel K, Moss A, Reddy KS, Douglas D, Mulligan D. Sclerosing peritonitis and mortality after liver transplantation. Liver Transpl 2009; 15:435-9. [PMID: 19326414 DOI: 10.1002/lt.21702] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sclerosing peritonitis describes the development of a peel or rind of fibrosis that spreads over the peritoneal surface and can lead to recalcitrant ascites, bowel obstruction, and sepsis. It is well described as a complication of peritoneal dialysis, especially with episodes of bacterial peritonitis. It is also a complication of end-stage liver disease with ascites and liver transplantation. This article describes 3 cases of sclerosing peritonitis present at the time of liver transplantation or soon after. All 3 patients had massive refractory ascites with episodes of spontaneous bacterial peritonitis prior to transplantation. Two patients had evidence of a fibrous peel at the time of transplantation. Postoperatively, all 3 patients continued to have refractory ascites and episodes of peritonitis, along with partial small bowel obstructions, abdominal pain, and malnutrition. Two patients also had constriction of the graft, including biliary obstruction and inferior vena cava and outflow obstruction, which has not been previously described. All 3 patients eventually died from complications related to the sclerosing peritonitis.
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Affiliation(s)
- Kristin Mekeel
- Division of Transplant Surgery, Mayo Clinic Hospital, Phoenix, AZ 85254, USA.
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Sigaroudinia MO, Baillie C, Ahmed S, Mallucci C. Sclerosing encapsulating peritonitis--a rare complication of ventriculoperitoneal shunts. J Pediatr Surg 2008; 43:E31-3. [PMID: 18485933 DOI: 10.1016/j.jpedsurg.2008.01.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2007] [Revised: 01/04/2008] [Accepted: 01/06/2008] [Indexed: 01/13/2023]
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare cause of bowel obstruction, most commonly associated with chronic ambulatory peritoneal dialysis. It has not previously been reported as a complication of ventriculoperitoneal (VP) shunts. We describe the clinical features of shunt-associated SEP and the important management considerations. Two children presented with small bowel obstruction after long-standing VP shunting of hydrocephalus. Neither had a history of recent shunt infection/revision nor evidence of shunt malfunction. In each case, the bowel was "cocooned" in a fibrous sheath with a notable absence of parietal adhesions. Both children were managed by meticulous adhesiolysis accompanied by shunt exteriorization. Both had prolonged ileus and required total parenteral nutrition. One required further laparotomy at which adhesiolysis was accompanied by irrigation with icodextrin 4% and systemic high-dose methylprednisolone. Weaning of steroids was accompanied by the introduction of azathioprine. A notable feature of intestinal obstruction because of SEP was severe pain despite adequate decompression. The restrictive "cocoon" that envelops the bowel prevents bowel dilatation and accounts for atypical radiologic findings in these cases.
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Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare complication of chronic peritoneal dialysis and beta-blocker (practolol) usage. The authors report a case of idiopathic SEP developing in a 39-year-old woman with associated ovarian cysts and kerato-conjunctivitis sicca syndrome. These associations have not been reported previously. The histological diagnosis of SEP was made after laparotomy for intestinal obstruction. The patient continues to have chronic intestinal failure, managed conservatively by long-term parenteral nutrition and steroids for more than 12 years.
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Ramos E, Molina M, Sarría J, Pérez-Moneo B, Burgos E, López-Santamaría M, Prieto G. Chronic rejection with sclerosing peritonitis following pediatric intestinal transplantation. Pediatr Transplant 2007; 11:937-41. [PMID: 17976132 DOI: 10.1111/j.1399-3046.2007.00798.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Intestinal transplantation is considered the usual treatment for patients with permanent intestinal failure when parenteral nutrition has failed. Chronic rejection is a complication difficult to diagnose because of the scarcity and lack of specificity in the symptoms and the characteristics of typical histological findings. We report the case of a four-yr-old patient who received an isolated intestinal transplant. After developing a chronic rejection he presented an intestinal obstruction secondary to a sclerosing peritonitis that required the surgical removal of the graft.
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Affiliation(s)
- Esther Ramos
- Service of Paediatric Gastroenterology and Nutrition, Hospital Infantil Universitario La Paz, Madrid, Spain
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Abstract
The abdominal cocoon is a rare disease that is characterized by total or partial encasement of the small bowel by a thick and fibrotic membrane. After an increased number of case reports, the characteristic age group and sex distribution of abdominal cocoon have changed. Although the etiology is unknown, congenital malformation is implicated as the causative factor in the two patients in this report. Although preoperative diagnosis is a matter of challenge and usually made at laparotomy, our experience suggests that computed tomographic evidence of clustered small bowel loops encased by a thin membrane-like sac is a characteristic preoperative finding in patients with abdominal cocoon. Surgical removal of the membrane and adhesions is the most appropriate choice of therapy.
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Bujalance Cabrera FM, Herrera Merino N, Salvador Fernández M, Escudero Escudero J, Sierra Ortega MA, Oliva Díaz C, Martínez Veiga JL. [Surgical treatment of sclerosing encapsulating peritonitis]. Cir Esp 2007; 81:139-43. [PMID: 17349238 DOI: 10.1016/s0009-739x(07)71285-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Sclerosing encapsulating peritonitis (SEP) or abdominal cocoon is a rare disease characterized by the formation of a fibrocollagenous membrane that wraps around the loops of the small bowel, producing obstruction. We present the results of the surgical treatment of this disease in three patients with chronic renal failure who developed SEP during the course of peritoneal dialysis (PD) and provide a literature review on the subject aimed at the general surgeon. PATIENTS AND METHOD In our area, the PD program treated 150 patients in 14 years, with seven cases of suspected SEP. In three patients, exploratory laparotomy was required. Clinical data, diagnostic imaging tests, type of surgery, immediate postoperative course, and status of the patient during subsequent follow-up are described. RESULTS In one of the three patients, bowel obstruction led to perforation requiring resection with anastomosis; the postoperative course was complicated and the patient died. In the remaining two patients, elective surgery was performed with the aim of removing the capsule enclosing the intestinal loops. In both patients the immediate postoperative course was favorable, although recurrence of intestinal encapsulation occurred in one patient. CONCLUSIONS The success of surgery in this disease is determined by the technique used. The correct technique consists of freeing the adhesions and extirpating of the capsule as far as possible. Perforation, as well as resection and intestinal anastomosis, significantly increase mortality.
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