Appearance of "collagen balls" in ascitic fluid cytology with abdominal cocoon (encapsulating peritonitis)

Acute presentation of cocoon abdomen as intestinal obstruction mimicking with strangulated eventration: A case report

INTRODUCTION

Abdominal cocoon syndrome (ACS), or sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction in which the bowel and internal abdominal organs are wrapped with a fibrocollagenous cocoon-like encapsulating membrane. While cocooning of the abdomen primarily manifests in individuals undergoing peritoneal dialysis (PD), it has also been reported to occur spontaneously. Remarkably rare, SEP may present with complete mechanical bowel obstruction in select cases.

CASE PRESENTATION

We hereby report a case of an 87-year-old female patient with a prior history of abdominal surgery, who presented to our emergency department with a clinical picture of complete small bowel obstruction. Clinical and radiological data were suggestive of a strangulated midline hernia, prompting a therapeutic laparotomy. The surgical exploration revealed the encasement of the small bowel loops within a thick fibrocollagenous membrane. Efficient resolution was achieved through skillful adhesiolysis and the meticulous excision of the fibrocollagenous membrane.

DISCUSSION

SEP is more prevalent in men, with a higher incidence observed in tropical and subtropical countries. While the precise pathophysiology remains elusive, it is hypothesized that subclinical intraabdominal inflammation gives rise to the formation of a dense fibrocollagenous membrane. This membrane encapsulates intraperitoneal organs, ultimately leading to intestinal obstruction. Patients typically present with a recurrent history of small bowel obstruction, notably in the absence of prior abdominal surgery. Abdominal CT scan with experienced radiologist interpretation can aid in preoperative diagnosis. In cases where non-operative management fails and recurrent obstructions persist, surgical adhesiolysis stands as the well-established gold standard.

CONCLUSION

SEP is a rare abdominal disease, posing challenges for preoperative diagnosis. Laparotomy plays an important role in its diagnosis and treatment. The primary objective of the surgical intervention is to release the encapsulation of the bowel and safeguard the optimal functioning of the small intestines as much as possible.

Introduction to the second edition of 'Diagnostic Cytopathology of Serous Fluids' as CytoJournal Monograph (CMAS) in Open Access

Serous fluids are excessive accumulation of fluids in a serous cavity as effusion. However, traditionally this area also covers cytopathologic evaluation of washings of these cavities including pelvic/peritoneal washing. This is the introductory review article in series on this topic with the application of simplified algorithmic approaches. The series would be compiled finally as a book after minor modifications of individual review articles to accommodate the book layout on the topic as second edition of 'Diagnostic Cytopathology of Serous Fluids' book. The approach is primarily directed towards detection of neoplastic cells based on morphology alone or with the help of various ancillary tests, including commonly applied immunocytochemistry to be interpreted as second foreign population with application of SCIP (subtractive coordinate immunoreactivity pattern) approach in effusion fluid tapings. As the role of molecular pathology tests is increasing, this component as ancillary testing will also be covered as applicable. Because a picture and sketches are worth a thousand words, illustrations and figures are included generously even at the risk of moderate repetition. The clinically important serous cavities include peritoneal cavity, pericardial cavity, and two pleural cavities. The primary topic of this series is specimens from these cavities as effusion fluids and washings including cytopathologic evaluation of peritoneal/pelvic washing. It is expected that some readers may not read the entire series or the final book from beginning to end, but refer to the individual review articles and chapters sporadically during their clinical practice. Considering this practical limitation, some brief repetition may be observed throughout the book. Some of the important themes will be highlighted as italicized and bolded text for quick reference. Dedicated articles/chapters are assigned for technical and other reference material as appendices. Tables, algorithms, sketches, and combination of pictures are included generously for quick reference. Most of the illustrations are attempted to be labeled appropriately with arrows and other indicators to avoid equivocation, especially for beginners in the field. This introductory review article describes general details under the following three broad headings: Histology and general cytology of serous cavity lining Effusion (general considerations) Ancillary techniques in brief.

Abdominal cocoon: report of a case

The abdominal cocoon is a rare cause of intestinal obstruction most often found in adolescent girls from tropical and subtropical countries. It is characterized by a thick fibrotic sac covering the small bowel partially or completely, the etiology of which is unknown. A correct diagnosis is not often made preoperatively; however, following simple surgical release of the entrapped bowel, these patients usually do well. We report herein our experience of a case of abdominal cocoon with a brief review of the medical literature on this unusual disease entity.

Abdominal cocoon in a man: preoperative diagnosis and literature review

Sclerosing encapsulating peritonitis, or abdominal cocoon, is a relatively rare cause of intestinal obstruction, described mostly in young adolescent girls. It is characterized by a thick fibrotic peritoneum that wraps the bowel in a concertinalike fashion with some adhesions. Because of its peculiar characteristics, this condition presents many difficulties in preoperative diagnosis. Recognition of the entity results in proper management and prevents unnecessary bowel resection. We report a man with intermittent intestinal obstruction and an abdominal cocoon encasing the small bowel that was diagnosed preoperatively by radiology. To the best of our knowledge, this represents the fourth male patient reported in the medical literature to develop this condition. We briefly review the literature and discuss the preoperative diagnosis and management of sclerosing encapsulating peritonitis.