Idiopathic sclerosing encapsulating peritonitis: abdominal cocoon

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.     

Accurate definition and management of idiopathic sclerosing encapsulating peritonitis

AIM: To review the literature on idiopathic sclerosing encapsulating peritonitis(SEP), also known as abdominal cocoon syndrome. METHODS: The Pub Med, 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 tothe 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 standardmanagement strategy.     

Conundrum of the Cocoon

Idiopathic, sclerosing, encapsulating peritonitis, or abdominal cocoon, is a rare cause of bowel obstruction in the elderly. A 65-year-old male patient presented with acute bowel obstruction caused by torsion of the encapsulated small bowel. He was treated successfully with subtotal excision of the fibrocollagenous membrane and small bowel resection. Despite anecdotal reports of a preoperative diagnosis, in the majority of cases, sclerosing, encapsulating peritonitis is a fortuitous finding. A better awareness of this condition may facilitate preoperative diagnosis.     

Idiopathic sclerosing encapsulating peritonitis （or abdominal cocoon）： A report of 5 cases

Sclerosing encapsulating peritonitis （SEP） is a rare cause of intestinal obstruction that is characterized by a thick grayish-white fibrotic membrane encasing the small bowel. SEP can be classified as idiopathic, also known as abdominal cocoon, or secondary. It is difficult to make a definite pre-operative diagnosis. We experienced five cases of abdominal cocoon, and the case files were reviewed retrospectively for the clinical presentation, operative findings and outcome. All the patients presented with acute, subacute and chronic intestinal obstruction. Computed tomography （CT） showed characteristic findings of small bowel loops congregated to the center of the abdomen encased by a soft-tissue density mantle in four cases. Four cases had an uneventful post-operative period, one case received second adhesiolysis due to persistent ileus. The imaging techniques may facilitate pre-operative diagnosis. Surgery is important in the management of SEP.     

Role of conservative management in tubercular abdominal cocoon: a case series

Background

Sclerosing encapsulating peritonitis (Abdominal cocoon) is an uncommon cause of intestinal obstruction and tuberculosis is an important etiology. Appropriate management of this entity is still uncertain.

Methods

We did a retrospective analysis of patients with abdominal cocoon who were seen over a two year period at a tertiary care center in North India. We included patients with tubercular abdominal cocoon (TAC) who were managed primarily with antitubercular therapy in the present report. The diagnosis of TAC was made using combination of criteria (radiological or surgical findings of cocoon with evidence of tuberculosis in form of microbiological, histological or biochemical evidence). The clinical presentation, outcome and need for surgery for these patients were retrieved from the records of these cases maintained in a database.

Results

Of 18 patients with abdominal cocoon, 15 patients had underlying tuberculosis. The median age was 28 years (interquartile range 24) and 12 (80%) were males. Three patients had confirmed tuberculosis on basis of microbiological evidence. All had abdominal pain for 1–9 months, and 11 had intestinal obstruction. Twelve patients had positive Mantoux test, none had HIV. Pulmonary tuberculosis was noted in four patients, pleural in five, splenic and intestinal in two each, hepatic and mediastinal lymph-nodal in one each. Thirteen patients were started on usual 4-drug anti-tubercular therapy (ATT) while two cirrhotics needed modified ATT. Three patients were on steroids with ATT and all three improved. One patient was lost to follow up. Of the rest 14 patients, 2 underwent surgery, 1 at initial presentation while another after 4 months of ATT. Overall five patients developed intestinal obstruction while on ATT, one needed surgery and one died of liver failure while others improved with conservative means.

Conclusion

TAC can be managed conservatively in a subset of patients.

     

Sclerosing encapsulating peritonitis: differential diagnosis to peritoneal encapsulation and abdominal cocoon--a case report.

A 59 year old man presented with symptoms of partial bowel obstruction. Small bowel x-ray studies did not allow to identify the nature of the intestinal process in the upper ileum. At laparotomy small bowel encapsulation with a whitish membrane was encountered. Despite partial removal of this membrane small bowel obstruction persisted and two weeks postoperatively the patient died of peritonitis and cardiac insufficiency. Autopsy findings revealed massive fibrous adhesions in the abdomen with granulomatous inflammation. The presence of foreign body giant cells and bifringent crystals were characteristic for talcum powder. The latter suggested a causal role of an appendectomy 45 years earlier. The diagnosis of sclerosing encapsulating peritonitis as established in our patient needs to be separated from peritoneal encapsulation, a congenital malformation, and abdominal cocoon, which contains histological elements of inflammation. This case report should draw attention to these entities in the differential diagnosis and surgical management of small bowel obstruction.     

La péritonite encapsulante. A propos d’un cas

Or sclerosing encapsulating peritonitis is diffuse peritoneal fibrosis may develop into a true sclerosis, or a hull sheathing peritoneal intestinal loops commonly found in a cocoon during laparoscopy or laparotomy. His diagnosis but especially pre-operative enables the surgeon to treat the patient optimally. The main etiologies are peritoneal dialysis, intraperitoneal chemotherapy, infections. We report a case of peritonitis encapsulating and discuss its main clinical and etiopathogenic.     

Sclerosing encapsulating peritonitis presenting with paroxysmal abdominal pain and strangulated mechanical bowel obstruction: A case report

Rationale:Sclerosing encapsulated peritonitis (SEP) is a rare chronic peritoneal inflammation with unknown etiology, and is also known as abdominal cocoon. This occurs when the intestinal annulus is enveloped in the peritoneal cavity, resulting in intestinal obstruction. Its preoperative diagnosis and treatment strategy remains a challenge.Patient concerns:The study reports a 53-year-old male, who presented with a 4-day history of paroxysmal abdominal pain, without the adverse reaction of nausea, vomiting, or diarrhea.Diagnosis:The accurate diagnosis of SEP was made after the emergency diagnostic laparoscopy.Interventions:The laparoscopic exploration revealed that the small intestine was wrapped by a layer of peritoneum. Then, the abdominal fibrous membrane was removed surgically, and adhesiolysis were performed. The patient recovered well, and gradually recovered by the 10^th post-operative day.Outcomes:The patient was discharged uneventfully after 10 days, and the patient recovered well. After the 12-month follow-up, no symptoms of recurrence or complications were observed.Lessons:The preoperative diagnosis of SEP remains difficult, and the onset of SEP has exhibited a younger trend. The diagnosis of SEP should remain on the list of differential diagnosis for paroxysmal abdominal pain. single-photon emission computed tomography/computed tomography and laparoscopic exploration have been proven to be helpful for establishing the diagnosis. In the early stage of intestinal obstruction caused by SEP, surgical intervention was immediately carried out in emergency department, and the patient recovered well after the operation. The present study also presents a review of the literature for other cases of SEP. The external evidence was helpful in making clinical decisions for patient care.     

Idiopathic abdominal cocoon syndrome with unilateral abdominal cryptorchidism and greater omentum hypoplasia in a young case of small bowel obstruction

Abdominal cocoon syndrome (ACS) is a rare cause of intestinal obstruction due to total or partial encapsulation of the small intestine by a fibrocollagenous membrane. Idiopathic ACS with abdominal cryptorchidism and greater omentum hypoplasia is even rarer clinically. We successfully treated a 26-year-old male case of small bowel obstruction with acute peritonitis. He was finally diagnosed with idiopathic ACS with unilateral abdominal cryptorchidism and greater omentum hypoplasia during exploratory laparotomy. He then underwent enterolysis, cryptorchidectomy, and appendectomy. He recovered gradually from the operations and early postoperative inflammatory ileus. There has been no recurrence of intestinal obstruction since the operation, and he is still in follow-up. We analyzed his clinical data and retrospectively reviewed the literature, and our findings may be helpful for the clinical diagnosis and treatment on ACS.     

Encapsulating peritonitis and familial Mediterranean fever

AIM: To investigate the relationship between encapsulating peritonitis and familial Mediterranean fever (FMF). METHODS: The patient had a history of type 2 diabetes and Iaparoscopic cholecystectomy was performed one year ago for cholelithiasis. Eleven months after the operation she developed massive ascites. Biochemical evaluation revealed hyperglycemia, mild Fe deficiency anemia, hypoalbuminemia and a CA-125 level of 2 700 IU. Ascitic evaluation showed characteristics of exudation with a cell count of 580/mm~3. Abdominal CT showed omental thickening and massive ascites. At exploratory laparotomy there was generalized thickening of the peritoneum and a Iaparoscopic clip encapsulated by fibrous tissue was found adherent to the uterus. Biopsies were negative for malignancy and a prophilactic total abdominal hysterectomy and bilateral salpingooophorectomy were performed. RESULTS: The histopathological evaluation was compatible with chronic nonspecific findings and mild mesothelial proliferation and chronic inflammation at the uterine serosa and liver biopsy showed inactive cirrhosis. CONCLUSION: The patient was evaluated as sclerosing encapsulating peritonitis induced by the iaparoscopic clip acting as a foreign body. Due to the fact that the patient had FMF the immune response was probably exaggerated.     

腹茧症的特点及诊治方法探讨（附7例报告）

为提高对腹茧症的认识临床诊治水平,分析了16年来经治的7例腹茧症患者的临床资料,结果临床表现为腹痛7例,腹胀4例,腹部包块2例,术前均示明确诊断,分别误诊为卵巢肿瘤蒂扭转2例,急性弥漫性腹膜炎1例,慢性阑尾炎1例,急、慢性肠梗阻3例。术中发现大网膜短缩3例、缺如4例,全部或部分小肠被一层灰白色致密坚韧的纤维膜包裹。均行手术治疗,术后病理检查确诊为腹茧症。提示该病临床表现无特异性,术前诊断困难,需手术及病理确诊,以手术治疗为主。     

Peritonitis in geriatric inpatients

Of 212 cases of peritonitis found in a retrospective study of geriatric inpatients, the most common causes were mesenteric infarction, malignancy, intestinal obstruction, perforated peptic ulcer, cholecystitis, diverticulitis and perforation of the urinary bladder. The diagnostic accuracy was 47%. Abdominal pain had been observed in only 55% of the cases, and guarding and/or abdominal rigidity in only 34%. Other findings such as tachycardia and fever were more common, but the specificities of these signs were low.     

原发性腹茧症合并隐睾术前误诊4例

目的:提高腹茧症的诊治水平.方法:我院2006-01/12收治的原发性腹茧症患者4例临床资料,以急性肠梗阻入院,查体发现均合并单侧隐睾,全部病例行剖腹探查.结果:术中证实腹茧症诊断,手术方案采取全部或部分包膜切除、肠黏连松解、肠排列术等,均痊愈出院.结论:腹茧症临床表现无特异性,术前诊断困难,对合并隐睾的肠梗阻应考虑到腹茧症的可能,手术治疗是腹茧症有效的治疗方法.     

Liver cirrhosis with encapsulating peritoneal sclerosis after 4 years of peritoneal dialysis: A case report

Rationale:Encapsulating peritoneal sclerosis (EPS), or abdominal cocoon, is a rare but fatal syndrome characterized by intestinal obstruction owing to adhesions in a diffusely thickened peritoneum. Long-term peritoneal dialysis (PD) for more than 5 years is commonly associated with EPS, while liver cirrhosis also carries a risk of EPS. However, there have been only a few reports that describe a case of EPS complicated with both cirrhosis and PD. We herein describe a case of advanced liver cirrhosis with end-stage renal disease (ESRD) who developed EPS after 4 years of PD and who was successfully recovered by surgery.Patient concerns:A 58-year-old man with alcoholic liver cirrhosis suffered abdominal pain. The patient had a 4-year history of continuous cycling PD to manage ESRD as well as cirrhotic complications of refractory ascites and hypotension. Laboratory test results showed increased levels of inflammation, and contrast-enhanced computed tomography scan showed dilated loops of small bowel proximal to the site of intestinal obstruction. The patient was suspected to have developed intestinal obstruction owing to EPS. The patient discontinued continuous cycling peritoneal dialysis and switched to hemodiafiltration.Diagnoses:Laparoscopy revealed a whitish membranous material wrapped around the bowel, especially at the terminal ileum with a narrowed portion, consistent with EPS.Interventions:Repeated decortication of fibrous peritoneal membranes successfully released the intestinal obstruction.Outcomes:The postoperative course went well and abdominal pain remained in remission. Because abdominal distension owing to ascites got intolerable in a few days after surgery, a PD catheter was re-inserted and ascitic fluid drainage was resumed with peritoneal lavage. The patient continued hemodiafiltration using vasopressor agents.Lessons:The Cirrhotic patient with ESRD undergoing PD could develop EPS after a short duration of PD.     

The comparison of accuracy and practicability between ultrasound and spiral CT in the diagnosis of intestinal obstruction: A protocol for systematic review and meta-analysis

Background:Acute abdominal pain is often caused by intestinal obstruction, with high morbidity, and mortality, so that the early diagnosis is particularly important. Currently, both spiral CT and ultrasound are common imaging diagnostic methods. However, the accuracy and practicality of the diagnosis are controversial. Therefore, the purpose of this study is to systematically evaluate the accuracy and practicality of spiral CT and ultrasound in the diagnosis of intestinal obstruction.Methods:Retrieval of English database (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese database (CNKI, WAN FANG, VIP, CBMDISC) by computers. From the establishment of the database to October 2020, a diagnostic experimental study on the diagnosis of intestinal obstruction by ultrasound and spiral CT was conducted. Two researchers independently conducted data extraction and quality evaluation of literature on the included studies, and Meta Disc1.4 and RevMan5.3 were used for meta-analysis on the included literature.Results:Sensitivity, specificity, po-sitive Likelihood ratio, NE-Gative likelihood ratio, diagnostic odds ratio and other indicators were used to determine the diagnostic efficacy of ultrasound and helical CT.Conclusion:This study is aimed at providing an evidence-based basis for clinicians to choose an appropriate or optimal diagnostic method by comparison of the accuracy and practicality between spiral CT and ultrasound in the diagnosis of intestinal obstruction.Ethics and dissemination:The private information from individuals will not be published. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences.OSF Registration number:DOI 10.17605/ OSF.IO / Q5RNS.     

Abdominal cocoon due to primary peritonitis: barium meal is valuable in diagnosis.

Abdominal cocoon, a rare condition in which the small bowel is encased in a membrane, resembles peritoneal fibrsis. There are only 16 case reports of this condition in the world literature. A 15-year-old girl presented with recurrent abdominal pain due to distal small bowel obstruction. Abdominal X-ray showed multiple air fluid levels like small intestinal obstruction. Contrast study revealed segregation of the small bowel loops with a dilatedproximal small intestine and gradual narrowing of the distal ileum with the obstruction; the mucosal pattern was preserved till the distal ileum. Contrast was not flowing into the colon. At laparotomy, the small intestine was seen to be encased and coiled up in a membrane. The membrane was excised, resulting in release of the obstruction.     

Laparoscopic Surgery for Adult Intussusception: Case Series

BackgroundIntussusception is a rare condition in adults which accounts for 1% of all intestinal obstructions. It usually requires surgical treatment and the classic approach is laparotomy. This article presented six adult patients who underwent laparoscopic surgery for intestinal obstruction due to intussusception.MethodBetween January 2017 and July 2019, six adult patients underwent laparoscopic surgery for intestinal obstruction due to intussusception. The patients were evaluated in terms of presenting symptoms, diagnosis, treatment modality, morbidity, mortality and histopathological results.ResultsAll patients presented with acute (50%) or subacute (50%) symptoms. All patients had intestinal obstruction (partial, complete) findings. Intussusception was diagnosed by abdominal computed tomography (CT). The patients with ileocolic and colo-colonic intussusception underwent colonoscopy. In the preoperative period, the etiology of intussusception (neoplasm, idiopathic, etc.) was diagnosed only in one patient (16.6%). Two patients underwent laparoscopic segmental small bowel resection, two patients underwent laparoscopic right hemicolectomy, one patient underwent laparoscopic left hemicolectomy, and one patient underwent laparoscopic anterior resection. None of the patients developed intraoperative or postoperative complication. The histopathological examination revealed malignancy in two patients (33.3%).ConclusionCT is helpful in diagnosing of adult intussusception. However, it is usually difficult to define the underlying pathology with CT. Laparoscopic approach seems to be safe and effective as open surgery, both in diagnosis and treatment of intussusception.     

Review of the literature and description of a case of sclerosing encapsulating peritonitis requiring home parenteral nutrition

We present a case of a 48 year old HIV patient, who had recurrent episodes of ascites since 2007. His history includes ischaemic heart disease, for which he was treated with atenolol from 2005 to 2007, and Type 2 diabetes; he was later started on propranolol 40 mg twice a day from 2007 for Didanosine-induced portal hypertension. Because of negative cultures and neutrophil count 相似文献   

Bezoar-induced small bowel obstruction: Clinical characteristics and diagnostic value of multi-slice spiral computed tomography

AIM: To determine the possible predisposing factors of bezoar-induced small bowel obstruction(b I-Sb O) and to discuss the diagnostic value of multi-slice spiral computed tomography,particularly contrast-enhanced scanning,in this condition.METHODS: A total of 35 b I-Sb O cases treated at our hospital from January 2007 to December 2013 were retrospectively analysed.Complete clinical and computed tomography(CT) data of the patients were available and confirmed by surgery.SbO was clinically diagnosed on the basis of clinical manifestations.Of the 35 patients,18 underwent abdominal and pelvic CT planar scanning with GE 64-slice spiral CT and 17 underwent abdominal and pelvic CT planar scanning with GE 64-slice spiral CT combined with contrastenhanced examination.Original images were processed using a GE ADW4.3 workstation to obtain MPR,CPR,MIP and CTA images.The images of all patients were evaluated by two abdominal imaging experts.The main analytical contents of planar scanning included intestinal bezoar conditions,changes in the intestinal wall and changes in peri-intestinal conditions.Vascular hyperaemia and arterial blood supply conditions at a specific obstruction site and the distal end of the obstruction site were evaluated through contrastenhanced examination.RESULTS: The proportion of males to females among the 35 cases was 1:1.69(13:22); median age was 63.3 years.The following cases were observed: 29(82.8%) cases occurred in autumn and winter and showed a history of consuming high amounts of persimmon and hawthorn; 19(54.3%) cases revealed a history of gastrointestinal surgery; 19 exhibited incomplete dentition,with missing partial or whole posterior teeth; 26 suffered from obstruction at the ileum.A total of 51 bezoars were found in these patients,of whom 16(45.7%) had multiple bezoars.CT planar scanning of bezoars showed lumps with mottled gas inside the intestinal cavity.Furthermore,9 cases of bezoars had envelopes and 11 cases were accompanied with thickening of the distal wall of the obstructed bowel.Scanning of 17 cases was enhanced; the results revealed that the mesenteric blood vessels at the obstruction site and the proximal site were dilated,and a total of 7 cases were accompanied with distal vascular dilation and intestinal wall thickening.CONCLUSION: b I-Sb O exhibits regional and seasonal characteristics.CT planar and contrast-enhanced scanning can be applied to diagnose and observe vascular conditions in obstructed zones.