Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2015; 21(2): 675-687
Published online Jan 14, 2015. doi: 10.3748/wjg.v21.i2.675
Accurate definition and management of idiopathic sclerosing encapsulating peritonitis
Sami Akbulut
Sami Akbulut, Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Turgut Ozal Medical Center, Malatya 44280, Turkey
Author contributions: Akbulut S designed the literature review, organized the report and wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Sami Akbulut, Assistant Professor, FICS, FACS, Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Turgut Ozal Medical Center, Elazig Yolu 8 km, Malatya 44280, Turkey.
Telephone: +90-422-3410660 Fax: +90-422-3410036
Received: July 30, 2014
Peer-review started: July 30, 2014
First decision: August 27, 2014
Revised: September 20, 2014
Accepted: December 1, 2014
Article in press: December 1, 2014
Published online: January 14, 2015

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.

Keywords: Sclerosisis encapsulation peritonitis, Primary, Idiopathic, Abdominal cocoon syndrome, Intestinal obstruction

Core tip: Idiopathic sclerosing encapsulating peritonitis (SEP) is a clinical entity characterized by partial or complete encasement of the small intestines by a thick fibrocollagenous membrane. While some patients with idiopathic SEP are asymptomatic, the majority of affected individuals develop acute, subacute or chronic attacks of gastrointestinal obstruction. Preoperative diagnosis of the disease is quite difficult, and many cases are diagnosed intraoperatively. Nonetheless, recent technological advances in imaging modalities, particularly computed tomography, have made preoperative diagnosis of SEP possible. Surgery remains the best management option for patients with severe signs of intestinal obstruction.