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Saha B, Parasar K, Anand U, Kant K. Idiopathic encapsulating peritoneal sclerosis presenting with abdominal mass. BMJ Case Rep 2024; 17:e262078. [PMID: 39266037 DOI: 10.1136/bcr-2024-262078] [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: 09/14/2024] Open
Abstract
A man in his late 30s presented with a history of recurrent colicky abdominal pain, bilious vomiting and intermittent mass formation in the lower abdomen. The mass was mobile, non-tender and fluctuant, and appeared in the right iliac fossa during episodes of pain and disappeared once the pain subsided. Contrast-enhanced CT (CECT) scan revealed a thick membrane-like structure covering the clumped small bowel loops, suggestive of an abdominal cocoon. A midline laparotomy was carried out with extensive adhesiolysis, and a membrane incision was performed. The final histopathological diagnosis was primary encapsulating peritoneal sclerosis. Encapsulating peritoneal sclerosis of idiopathic origin is rare and typically presents as an acute or subacute intestinal obstruction. A CECT scan is the diagnostic modality of choice, with a thick peritoneal membrane covering the small bowel loops being the hallmark sign. Surgical intervention is the preferred treatment for idiopathic cases, while medical management may address secondary causes.
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Affiliation(s)
- Bijit Saha
- Surgical Gastroenterology, AIIMS Patna, Patna, Bihar, India
- Surgical Gastroenterology, AIIMS Patna, Patna, Bihar, India
| | - Kunal Parasar
- Surgical Gastroenterology, AIIMS Patna, Patna, Bihar, India
| | - Utpal Anand
- Surgical Gastroenterology, AIIMS Patna, Patna, Bihar, India
| | - Kislay Kant
- Surgical Gastroenterology, AIIMS Patna, Patna, Bihar, India
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Di Buono G, Romano G, Amato G, Barletta G, Romano G, Adelfio N, Geraci G, Agrusa A. Surgical Management of Complicated Abdominal Tuberculosis: The First Systematic Review-New Treatments for an Ancient Disease and the State of the Art. J Clin Med 2024; 13:4894. [PMID: 39201035 PMCID: PMC11355769 DOI: 10.3390/jcm13164894] [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: 07/03/2024] [Revised: 07/18/2024] [Accepted: 07/22/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Abdominal tuberculosis comprises all forms of tuberculosis that involve the gastrointestinal tract. Controversies exist regarding the surgical approach and timing and type of intervention for complicated forms of abdominal tuberculosis. The aim of this systematic review is to define the rate of surgical treatment, the type of surgical procedures performed and the role of minimally invasive surgery in the management of abdominal tuberculosis. Methods: The literature in MEDLINE, Scopus and Google Scholar and forward and backward citations for studies published between database inception and July 2022 were searched without language restrictions. All prospective and retrospective studies were included. The electronic database search yielded 2440 records. Additionally, eight records were identified through snowball searching. Following duplicate removal (45 duplicates found), 2403 records were screened for titles and abstracts. After screening for titles and abstracts and exclusion criteria, 38 reports were included for systematic review, 27 retrospective studies and 11 prospective studies. Data extracted included the general and demographic characteristics of the studies, diagnostic methods used, clinical presentation, site of involvement and details on surgical treatment. Results: In total, 2870 patients with a diagnosis of abdominal tuberculosis were included, and 1803 (63%) underwent a surgical procedure. The majority of patients underwent an open surgical procedure (95%). The most commonly performed procedures were adhesiolysis (21%) and small bowel resection with primary anastomosis (21%). Conclusions: The results of this review suggest that whenever surgery is required, there is a tendency to perform open surgical procedures in patients with complicated abdominal tuberculosis, both in emergency and elective settings, despite advances in minimally invasive surgery. The study protocol was registered on PROSPERO (CRD42022354322).
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Affiliation(s)
- Giuseppe Di Buono
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90133 Palermo, Italy; (G.R.); (G.A.); (G.B.); (G.R.); (N.A.); (G.G.); (A.A.)
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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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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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Brückner M, Bogisch S. Laparoscopic ovariectomy in a dog with type III sclerosing encapsulating peritonitis and literature review. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2022; 50:138-143. [PMID: 35523167 DOI: 10.1055/a-1811-4052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sclerosing encapsulating peritonitis is a rare and not well-recognized disease in veterinary medicine. A 14-month-old female intact mixed-breed dog was diagnosed with sclerosing encapsulating peritonitis (SEP) at the age of 5 months after a routine work-up including biopsies from an exploratory laparotomy. Symptomatic treatment with an immunosuppressive dose of prednisolone was started, but dose reduction was unsuccessful. Combined treatment with tamoxifen, a selective estrogen receptor modulator used for its TGF-β1 suppression of fibroblasts was discussed; the owner was informed about the risk for developing a pyometra. About one year later the owner wanted to spay her dog and an ovariectomy was recommended, especially due to the extensive adhesions. A laparoscopic approach was chosen to reduce the amount of intraoperative tissue manipulation and inflammation, as well as to minimize the size of the incision. The dog continues to be doing well one year after surgery and prednisolone could be reduced to a low maintenance dose after surgery; so far, the addition of tamoxifen was not required. In selected cases, laparoscopy appears as a safe alternative in patients with adhesions, but the surgeon should always be prepared to convert in case of impaired vision, especially in the absence of tactile sensation. This case report is the first description of laparoscopy in a dog with SEP. Laparoscopy may serve as an easily accomplished minimally invasive method to diagnose SEP, but further studies are required.
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Park GH, Lee BC, Hyun DW, Choi JB, Park YM, Jung HJ, Jo HJ. Mechanical intestinal obstruction following laparoscopic inguinal hernia repair in a patient with abdominal cocoon syndrome. J Surg Case Rep 2019; 2019:rjz370. [PMID: 31867099 PMCID: PMC6917468 DOI: 10.1093/jscr/rjz370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/26/2019] [Indexed: 12/11/2022] Open
Abstract
Abdominal cocoon syndrome (ACS) is a rare condition characterized by partial or complete encasement of small intestine by a thick fibro-collagenous membrane. A 65-year-old man presented to the surgical department with left inguinal. He underwent laparoscopic transabdominal preperitoneal inguinal hernia. When we inserted a trocar into the peritoneal cavity, the small intestine was injured and repaired immediately. We identified a fibrotic membrane covering the small intestine, which was found as ACS. Two weeks later after discharge, he presented to the emergency department with mechanical intestinal obstruction. Conservative treatment had no effect on the patient and membrane excision, adhesiolysis and small intestine resection with anastomosis were performed. Unfortunately, the patient was hospitalized for a long time with bowel leakage and discharged on postoperative day 48. The preoperative diagnosis is quite challenging and most cases are diagnosed intraoperatively. When finding the ACS during the operation, careful attention should be needed.
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Affiliation(s)
- Geon Hi Park
- Department of Surgery, Pusan National University Hospital, Busan 49241, Korea
| | - Byoung Chul Lee
- Department of Surgery, Pusan National University Hospital, Busan 49241, Korea
| | - Dong Woo Hyun
- Department of Surgery, Pusan National University Hospital, Busan 49241, Korea
| | - Jung Bum Choi
- Department of Surgery, Pusan National University Hospital, Busan 49241, Korea
| | - Young Mok Park
- Department of Surgery, Pusan National University Hospital, Busan 49241, Korea
| | - Hyuk Jae Jung
- Department of Surgery, Pusan National University Hospital, Busan 49241, Korea
| | - Hong Jae Jo
- Department of Surgery, Pusan National University Hospital, Busan 49241, Korea
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Abstract
A 23-year-old man presented to the emergency department with a history of recurrent episodes of subacute intestinal obstruction. Palpation revealed a firm, non-tender, mobile, non-pulsatile mass of size 8-10 cm with indistinct margins and smooth surface in the hypogastrium. Contrast-enhanced CT scan of the abdomen showed clumping of the small bowel loops within a well-defined membrane-like structure without dilatation or thickening of bowel loops. The patient underwent a laparotomy with incision of the membrane and separation of all the small bowel loops inside the cocoon. Abdominal cocoon is the idiopathic variety of sclerosing encapsulating peritonitis and is an unusual cause of acute or subacute intestinal obstruction. Clinical diagnosis is difficult because of non-specific symptoms. CT has facilitated accurate preoperative diagnosis, long before the patient presents with full-fledged symptoms of acute intestinal obstruction. CT scan plays a significant role in excluding the secondary causes and helps in patient management.
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Affiliation(s)
- Sudipta Mohakud
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Odisha, India
| | - Aparna Juneja
- Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Hira Lal
- Radiodiagnosis, SGPGIMS, Lucknow, Uttar Pradesh, India
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Li S, Wang JJ, Hu WX, Zhang MC, Liu XY, Li Y, Cai GF, Liu SL, Yao XQ. Diagnosis and Treatment of 26 Cases of Abdominal Cocoon. World J Surg 2017; 41:1287-1294. [PMID: 28050667 DOI: 10.1007/s00268-016-3855-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Abdominal cocoon (AC) is a rare abdominal disease with nonspecific clinical features, and it is difficult to be diagnosed before operation and hard to be treated in clinical practice. The aim of this study is to investigate the diagnosis and treatment of AC. METHODS The clinical manifestations, findings during surgery, treatments, and follow-up results of 26 cases of AC were retrospectively studied from January 2001 to January 2015. RESULTS All of 26 cases were diagnosed as AC definitely by laparotomy or laparoscopic surgery. Their clinical findings were various, with 7 intestines obstructed with bezoars and 4 intestines perforated by spiny material. Based on the existence of the second enterocoelia, all cases were categorized into 2 types: type I is absent of second enterocoelia (18 cases, 69.23%), while type II shows second enterocoelia (8 cases, 30.77%). Twenty cases (12 were type I and 8 were type II) underwent membrane excision and careful enterodialysis to release the small intestine entirely or partially, while the other 6 cases (all were type I) did not. In addition, all patients were treated with medical treatment and healthy diet and lifestyle. Finally, most of the patients recovered smoothly. CONCLUSIONS AC can be categorized into two types; surgery is recommended for type II and part of type I with severe complications, but sometimes conservative therapy might be appropriate for type I. Laparoscopic surgery plays an important role in the diagnosis and treatment of AC. Furthermore, favorite health education, healthy diet and lifestyle are of significance in patients' recovery.
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Affiliation(s)
- Sheng Li
- Southern Medical University, Guangzhou, China.,Department of Gastrointestinal Surgery, Central Hospital of Shaoyang, Shaoyang, Hunan, China.,Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jun-Jiang Wang
- Southern Medical University, Guangzhou, China.,Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei-Xian Hu
- Southern Medical University, Guangzhou, China.,Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mou-Cheng Zhang
- Southern Medical University, Guangzhou, China.,Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Gastrointestinal Surgery, First Hospital of Ningbo, Ningbo, Zhejiang, China
| | - Xian-Yan Liu
- Department of Gastrointestinal Surgery, Central Hospital of Shaoyang, Shaoyang, Hunan, China
| | - Yong Li
- Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guan-Fu Cai
- Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Sen-Lin Liu
- Department of Gastrointestinal Surgery, Central Hospital of Shaoyang, Shaoyang, Hunan, China
| | - Xue-Qing Yao
- Southern Medical University, Guangzhou, China. .,Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China.
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9
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Contribution of laparoscopy in small bowel obstruction: Report on two rare causes of small bowel obstruction. APOLLO MEDICINE 2017. [DOI: 10.1016/j.apme.2016.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Intestinal Obstruction in a Patient with Sclerosing Encapsulating Peritonitis. Case Rep Surg 2017; 2017:8316147. [PMID: 28458941 PMCID: PMC5385222 DOI: 10.1155/2017/8316147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 03/06/2017] [Accepted: 03/19/2017] [Indexed: 01/01/2023] Open
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare disorder that is characterized by encapsulation of bowel loops by thick fibrinogenous case. Most patients present with vague abdominal symptoms. It is challenging to diagnose the condition preoperatively. Surgical management is preserved for patients with small bowel obstruction with no improvement on conservative measures or for those with signs of bowel ischemia (Li et al., 2014; Habib et al. 2011). Herein, we discuss the clinical signs and symptoms, the radiological features, the surgical management, and outcome of SEP based on a patient who underwent surgery in our hospital.
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SINGAL RIKKI, SATYASHREE B, MITTAL AMIT, SHARMA BHANUPRATAP, SINGAL SAMITA, ZAMAN MUZZAFARR, SHARDHA PARTEEK. Tubercular abdominal cocoon in children - a single centre study in remote area of northern India. CLUJUL MEDICAL (1957) 2017; 90:179-184. [PMID: 28559702 PMCID: PMC5433570 DOI: 10.15386/cjmed-725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/02/2016] [Accepted: 11/08/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Amongst the numerous causes of intestinal obstruction listed in the literature, sclerosing encapsulating peritonitis also called Abdominal Cocoon (AC) is one of the rarest entities. Its characteristic feature is a thick fibrotic membrane encasing varying lengths of the small and large gut in a cocoon. In India, there is an increasing incidence of tuberculosis, especially in the rural areas. AIMS AND OBJECTIVES The aim of this study was to investigate the clinical presentation and evaluate the operative findings of tuberculous AC. We also evaluated the outcomes and response to anti tuberculous treatment (ATT) in all the patients diagnosed with this condition. MATERIAL AND METHODS This study was carried out at M.M. Institute of Medical Sciences and Research, Mullana, Ambala, India between April 2013 - March 2016 in the Department of Pediatric Surgery. This is a prospective study. A total of 17 patients diagnosed with abdominal cocoon secondary to tuberculosis have been included in the study. RESULTS A total of 17 patients presented to the emergency ward with features of acute intestinal obstruction. The average age was 15.3 years (range 9 years to 16 years). There were 14 females and 3 males. All patients presented with abdominal pain, bilious vomiting, constipation and abdominal distention. The patients were operated in our hospital and relieved of their obstruction. Based on their operative findings and after histopathological confirmation, patients were given ATT. In the follow-up, all patients did well, without recurrence of tuberculosis or intestinal obstruction. CONCLUSION Tuberculosis as a cause of childhood AC is rather common in developing countries and is potentially a fatal condition. A strong clinical suspicion, sonographic and computed tomography scan findings help establish a pre-operative diagnosis. Tuberculous AC has a strong prevalence in females. Surgery is the mainstay of treatment followed by anti-tuberculous drugs.
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Affiliation(s)
- RIKKI SINGAL
- Department of Surgery - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
- Address for correspondence:
| | - B SATYASHREE
- Department of Pediatric Surgery - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
| | - AMIT MITTAL
- Department of Radiodiagnosis and Imaging - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
| | - BHANU PRATAP SHARMA
- Department of Surgery - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
| | - SAMITA SINGAL
- Department of Radiodiagnosis and Imaging - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
| | - MUZZAFARR ZAMAN
- Department of Surgery - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
| | - PARTEEK SHARDHA
- Department of Surgery - M.M. Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India
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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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Yavuz R, Akbulut S, Babur M, Demircan F. Intestinal Obstruction Due to Idiopathic Sclerosing Encapsulating Peritonitis: A Case Report. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e21934. [PMID: 26082852 PMCID: PMC4464369 DOI: 10.5812/ircmj.17(5)2015.21934] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 03/23/2015] [Accepted: 04/11/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Sclerosing encapsulating peritonitis (SEP) is characterized by partial or complete encasement of small intestine by a thick fibrocollagenous membrane. Depending on underlying causes, SEP is divided into primary and secondary forms. Idiopathic SEP is also called idiopathic or abdominal cocoon syndrome. Herein we presented a case of idiopathic SEP. CASE PRESENTATION A 90-year-old male patient presented to our emergency department with signs and symptoms of intestinal obstruction and dehydration. Physical examination findings, patient's age and plain abdominal radiography were consistent with tumoral obstruction or viscus perforation. Explorative laparotomy revealed a fibrous capsule encasing intestines as well as dense adhesions between intestinal loops. Since the overall condition of the patient was not well enough to allow a wide dissection and membrane excision, the operation was terminated after performing a limited loop ileostomy. Unfortunately, the patient was lost due to organ failure at the postoperative period. CONCLUSIONS Despite advances in radiological techniques, the exact diagnosis in many cases is still made according to intraoperative findings and histopathological properties of the excised membrane. While some cases of SEP remain asymptomatic for years, most cases are characterized by recurrent bouts of acute, subacute or chronic intestinal obstruction. To our knowledge, the case presented here is the oldest patient with idiopathic SEP in the literature.
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Affiliation(s)
- Ridvan Yavuz
- Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
| | - Sami Akbulut
- Department of Surgery, Liver Transplant Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Mehmet Babur
- Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
| | - Firat Demircan
- Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
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Akbulut S. Accurate definition and management of idiopathic sclerosing encapsulating peritonitis. World J Gastroenterol 2015; 21:675-687. [PMID: 25593498 PMCID: PMC4292304 DOI: 10.3748/wjg.v21.i2.675] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/20/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
AIM To review the literature on idiopathic sclerosing encapsulating peritonitis (SEP), also known as abdominal cocoon syndrome. METHODS The PubMed, MEDLINE, Google Scholar, and Google databases were searched using specific key words to identify articles related to idiopathic SEP. These key words were "sclerosing encapsulating peritonitis," "idiopathic sclerosing encapsulating peritonitis," "abdominal cocoon," and "abdominal cocoon syndrome." The search included letters to the editor, case reports, review articles, original articles, and meeting presentations published in the English-language literature from January 2000 to May 2014. Articles or abstracts containing adequate information about age, sex, symptom duration, initial diagnosis, radiological tools, and surgical approaches were included in the study. Papers with missing or inadequate data were excluded. RESULTS The literature search yielded 73 articles on idiopathic (primary) SEP published in 23 countries. The four countries that published the greatest number of articles were India (n = 21), Turkey (n = 14), China (n = 8) and Nigeria (n = 3). The four countries that reported the greatest number of cases were China (n = 104; 53.88%), India (n = 35; 18.13%), Turkey (n = 17; 8.80%) and Nigeria (n = 5; 2.59%). The present study included 193 patients. Data on age could be obtained for 184 patients (range: 7-87 years; mean ± SD, 34.7 ± 19.2 years), but were unavailable for nine patients. Of the 184 patients, 122 were male and 62 were female; sex data could not be accessed in the remaining nine patients. Of the 149 patients whose preoperative diagnosis information could be obtained, 65 (43.6%) underwent operations for abdominal cocoon, while the majority of the remaining patients underwent operations for a presumed diagnosis of intestinal obstruction and/or abdominal mass. Management information could be retrieved for 115 patients. Of these, 68 underwent excision + adhesiolysis (one laparoscopic); 24 underwent prophylactic appendectomy in addition to excision + adhesiolysis. Twenty patients underwent various resection and repair techniques along with excision + adhesiolysis. The remaining three patients were managed with antituberculosis therapy (n = 2) and immunosuppressive therapy (n = 1). CONCLUSION Idiopathic SEP is a rare disorder characterized by frequently recurring bouts of intestinal obstruction. Surgical therapy is the gold standard management strategy.
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Stewart D, Rampersad R, King SK. Peritoneal encapsulation as a cause for recurrent abdominal pain in a 16-year-old male. ANZ J Surg 2014; 87:414-415. [PMID: 25387831 DOI: 10.1111/ans.12907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- David Stewart
- Department of Paediatric and Neonatal Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Rajay Rampersad
- Department of Paediatric and Neonatal Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sebastian K King
- Department of Paediatric and Neonatal Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Surgical Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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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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Nandedkar S, Malukani K, Nayak R, Patidar E. Sclerosing encapsulating peritonitis: a case series. Indian J Gastroenterol 2014; 33:183-7. [PMID: 24214583 DOI: 10.1007/s12664-013-0432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/15/2013] [Indexed: 02/04/2023]
Abstract
Sclerosing encapsulating peritonitis (SEP) is a relatively rare cause of intestinal obstruction characterized by total or partial encapsulation of the small intestine by a thick fibrous membrane and is a difficult preoperative diagnosis. A series of seven cases of SEP is reported. Modalities of preoperative diagnosis along with clinical presentation, operative findings, and histopathology are discussed.
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Affiliation(s)
- Shirish Nandedkar
- Department of Pathology, Sri Aurobindo Institute of Medical Sciences, Indore Ujjain State Highway, Near MR 10 Crossing, Indore, 453 111, 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. [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: 05/10/2023] 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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Hu D, Wang R, Xiong T, Zhang HW. Successful delivery after IVF-ET in an abdominal cocoon patient: case report and literature review. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2013; 6:994-997. [PMID: 23638238 PMCID: PMC3638117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 03/23/2013] [Indexed: 06/02/2023]
Abstract
Abdominal cocoon (AC) is a rare condition of uncertain etiology. We report the case of a 29-year-old infertile Chinese woman with AC, who successfully got twin pregnancy and delivery through in vitro fertilization (IVF) and embryo transfer (ET). And this review discusses the current concepts of its pathogenesis, diagnosis and treatments. AC might lead to tubal infertility and IVF-ET would be the most effective remedy for the patients desiring pregnancy.
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Affiliation(s)
- Dan Hu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, The People's Republic of China
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Tannoury JN, Abboud BN. Idiopathic sclerosing encapsulating peritonitis: abdominal cocoon. World J Gastroenterol 2012; 18:1999-2004. [PMID: 22563185 PMCID: PMC3342596 DOI: 10.3748/wjg.v18.i17.1999] [Citation(s) in RCA: 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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