• encapsulating peritoneal sclerosis
• gastroenterology
• general surgery
• infectious disease
• tuberculosis

Abdominal cocoon is a unique peritoneal disease that is frequently misdiagnosed. The occurrence of the abdominal cocoon with a jejuno-ileo-colonic fistula has not been previously reported.

We admitted a 41-year-old female patient with an abdominal cocoon and a jejuno-ileo-colonic fistula. She was admitted to our hospital for the following reasons: “the menstrual cycle is prolonged for half a year, and fatigue, palpitations, and shortness of breath for 2 months”. On the morning of the 4th day of admission, the patient experienced sudden, severe, and intolerable abdominal pain after defecating. An emergency abdominal CT examination revealed intestinal obstruction. Surgery was performed, and the small intestine and colon were observed to be conglutinated and twisted into a mass surrounded by a fibrous membrane, and an enteroenteric fistula was observed between the jejunum, ileum, and sigmoid colon. We successfully relieved the intestinal obstruction and performed adhesiolysis. The patient was discharged from our hospital on the 6th postoperative day, then she recovered and was discharged from Feicheng People's Hospital after another 11 days of conservative treatment, and she recovered well-during the 2-month follow-up period.

Abdominal cocoon coexisting with a jejuno-ileo-colonic fistula is very rare. During the process of abdominal cocoon treatment, the patient's medical history should be understood in detail before the operation, and the abdominal organs should be carefully evaluated during the operation to avoid missed diagnoses.

Congenital peritoneal encapsulation (CPE) is a very rare, congenital condition characterised by the presence of an accessory peritoneal membrane which encases a variable extent of the small bowel. It is unclear how CPE develops, however it is currently understood to be a result of an aberrant adhesion in the peritoneal lining of the physiological hernia in foetal mid-gut development. The condition was first described in 1868, and subsequently there have been only 45 case reports of the phenomenon. No formal, systematised review of CPE has yet been performed, meaning the condition remains poorly understood, underdiagnosed and mismanaged. Diagnosis of CPE remains clinical with important adjuncts provided by imaging and diagnostic laparoscopy. Two thirds of patients present with abdominal pain, likely secondary to sub-acute bowel obstruction. A fixed, asymmetrical distension of the abdomen and differential consistency on abdominal palpation are more specific clinical features present in approximately 10% of cases. CPE is virtually undetectable on plain imaging, and is only detected on 40% of patients with computed tomography scan. Most patients will undergo diagnostic laparotomy to confirm the diagnosis. Management of CPE includes both medical management of the critically-unstable patient and surgical laparotomy, partial peritonectomy and adhesiolysis. Prognosis following prompt surgical treatment is excellent, with a majority of patients being symptom free at follow up. This review summarises the current literature on the aetiology, diagnosis and treatment of this rare disease. We also introduce a novel classification system for encapsulating bowel diseases, which may distinguish CPE from the commoner, more morbid conditions of abdominal cocoon and encapsulating peritoneal sclerosis.

• Congenital
• Encapsulation
• Peritoneum
• Cocoon
• Sclerosis

• Humans
• Intestinal Obstruction/classification
• Intestinal Obstruction/congenital
• Intestinal Obstruction/surgery
• Intestine, Small/pathology
• Intestine, Small/surgery
• Peritoneal Fibrosis/classification
• Peritoneal Fibrosis/congenital
• Peritoneal Fibrosis/surgery
• Peritoneum/abnormalities
• Peritoneum/pathology
• Prognosis
• Treatment Outcome

Encapsulating peritoneal sclerosis (EPS) is a debilitating condition characterized by a fibrocollagenous membrane encasing the small intestine, resulting in recurrent small bowel obstructions. EPS is most commonly associated with long-term peritoneal dialysis, though medications, peritoneal infection, and systemic inflammatory disorders have been implicated. Many cases remain idiopathic. Diagnosis is often delayed given the rarity of the disorder combined with non-specific symptoms and laboratory findings. Although cross-sectional imaging with computed tomography of the abdomen can be suggestive of the disorder, many patients undergo exploratory laparotomy for diagnosis. Mortality approaches 50% one year after diagnosis. Treatment for EPS involves treating the underlying condition or eliminating possible inciting agents (i.e. peritoneal dialysis, medications, infections) and nutritional support, frequently with total parenteral nutrition. EPS-specific treatment depends on the disease stage. In the inflammatory stage, corticosteroids are the treatment of choice, while in the fibrotic stage, tamoxifen may be beneficial. In practice, distinguishing between stages may be difficult and both may be used. Surgical intervention, consisting of peritonectomy and enterolysis, is time-consuming and high-risk and is reserved for situations in which conservative medical therapy fails in institutions with surgical expertise in this area. Herein we review the available literature of the etiology, pathogenesis, diagnosis, and treatment of this rare, but potentially devastating disease.

• Abdominal cocoon
• Sclerosing encapsulating peritonitis
• Peritoneal sclerosis
• Peritonectomy
• Enterolysis
• Peritoneal dialysis
• Tamoxifen
• Corticosteroids

• Glucocorticoids/therapeutic use
• Humans
• Intestinal Obstruction/diagnosis
• Intestinal Obstruction/etiology
• Intestinal Obstruction/mortality
• Intestinal Obstruction/therapy
• Intestine, Small/diagnostic imaging
• Intestine, Small/pathology
• Intestine, Small/surgery
• Parenteral Nutrition, Total
• Peritoneal Dialysis/adverse effects
• Peritoneal Fibrosis/diagnosis
• Peritoneal Fibrosis/etiology
• Peritoneal Fibrosis/mortality
• Peritoneal Fibrosis/therapy
• Peritoneum/diagnostic imaging
• Peritoneum/pathology
• Peritoneum/surgery
• Peritonitis/complications
• Peritonitis/therapy
• Recurrence
• Sclerosis
• Tamoxifen/therapeutic use
• Tomography, X-Ray Computed
• Treatment Outcome

• Chorionic Gonadotropin/blood
• Female
• Gestational Trophoblastic Disease/complications
• Gestational Trophoblastic Disease/drug therapy
• Humans
• Lung Neoplasms/drug therapy
• Lung Neoplasms/secondary
• Methotrexate/therapeutic use
• Methotrexate/toxicity
• Middle Aged
• Neoplasm Staging
• Peritonitis/chemically induced
• Peritonitis/complications
• Peritonitis/pathology
• Peritonitis/surgery
• Pregnancy
• Serositis/chemically induced
• Serositis/complications
• Serositis/diagnosis

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.

• Abdominal cocoon
• Adults
• Encapsulating peritonitis
• Intestinal obstruction
• Sclerosing peritonitis