Computed tomography in abdominal cocoon

Two Different Clinical Approaches with Mortality Assessment of Four Cases: Complete and Incomplete Type of Abdominal Cocoon Syndrome

Abdominal cocoon syndrome (ACS), also called sclerosing encapsulated peritonitis, is a condition characterized by encapsulation of all or some of small bowel loops by a thick fibrous membrane. Etiologic cause is not fully known. It is among the rare causes of intestinal obstruction in adults. Preoperative diagnosis is difficult, and high suspicion is required. Diagnosis is generally made during laparotomy performed due to mechanical obstruction. In treatment of the condition, large scale surgical resections should be avoided. In the present study, we aimed to evaluate all clinical and radiological characteristics and surgical treatment of ACS in light of the literature through four patients operated in our clinic.

An unusual case of cocoon abdomen in a patient on hemodialysis

“Cocoon abdomen” or sclerosing encapsulating peritonitis is a rare cause of intestinal obstruction. It has been described in patients on continuous ambulatory peritoneal dialysis. The exact etiology is unknown, but pathogenesis rests on chronic peritoneal inflammation. No case has been reported so far in patients on hemodialysis. We hereby report a case of cocoon abdomen presenting as refractory ascites with intestinal obstruction in a patient on maintenance hemodialysis.

Abdominal cocoon in a young man

BACKGROUND

Intestinal obstruction remains a common problem encountered in the surgical emergency, and usually occurs secondary to adhesions, obstructed herniae or tubercular strictures. However, at times, rare causes of obstruction can also be encountered.

METHODS

A 24-year-old male patient presented with recurrent episodes of intestinal obstruction that was found to be secondary to an abdominal cocoon on laparotomy.

RESULTS

The patient underwent adhesiolysis of the cocoon, and remains well on a follow-up. Histopathological report of the cocoon wall revealed fibrocollagenic tissues with a mixed inflammatory infiltrate, without any evidence of tuberculosis.

CONCLUSIONS

Abdominal cocoon can be a rare cause of intestinal obstruction in male patients. Adhesiolysis of the cocoon membrane releases the obstruction and gives good results.

Abdominal cocoon in a young man

BACKGROUND

Intestinal obstruction remains a common problem encountered in the surgical emergency, and usually occurs secondary to adhesions, obstructed herniae or tubercular strictures. However, at times, rare causes of obstruction can also be encountered.

METHODS

A 24-year-old male patient presented with recurrent episodes of intestinal obstruction that was found to be secondary to an abdominal cocoon on laparotomy.

RESULTS

The patient underwent adhesiolysis of the cocoon, and remains well on a follow-up. Histopathological report of the cocoon wall revealed fibrocollagenic tissues with a mixed inflammatory infiltrate, without any evidence of tuberculosis.

CONCLUSIONS

Abdominal cocoon can be a rare cause of intestinal obstruction in male patients. Adhesiolysis of the cocoon membrane releases the obstruction and gives good results.

Additive effectiveness of everolimus plus tamoxifen therapy in treatment of encapsulating peritoneal sclerosis

Peritoneal dialysis (PD) is one of the commonly used choices of continuous renal replacement therapies. Peritoneal membrane is damaged by using solutions with lower biocompatibility, peritonitis episodes, and vintage of PD therapy. Encapsulating peritoneal sclerosis (EPS) is a rare complication of PD and is presented by progressive fibrosis of the peritoneum. Fibrous tissue entrapment of the intestine, leading to complete intestinal obstruction, is referred to as EPS, the most severe form of sclerosing peritonitis. EPS is irreversible fibrosis of the peritoneal membrane usually associated with high rates of morbidity and mortality. Preventive strategies are the best choice of treatment. Also there is no proven effective therapy for EPS; there are only small-sized trials. Herein we present a case of EPS who improved with everolimus plus tamoxifen therapy.

Abdominal cocoon secondary to tuberculosis

Abdominal cocoon or sclerosing encapsulating peritonitis is a rare cause of intestinal obstruction that has been described mostly in young adolescent girls. Thick fibrotic peritoneum encasing the small bowel in a small volume is a pathognomonic feature. This condition presents many difficulties in preoperative diagnosis. Early diagnosis can result in proper management, and may prevent the need for bowel resection. The author reports a case of a male patient with intermittent subacute intestinal obstruction and an abdominal cocoon encasing the small bowel secondary to abdominal tuberculosis, which was suspected preoperatively by radiology. To the best of our knowledge, this case represents one of the very few male patients with this disease entity reported in medical literature.

Epidemiology of abdominal cocoon in China during the past 14 years

AIM: To study the epidemiological features of abdominal cocoon and its diagnosis and treatment in China during the past 14 years.

METHODS: Reports on abdominal cocoon published from January 1994 to June 2007 were retrieved from various databases, such as Chinese Medical Current Content (CBM) and National Knowledge Infrastructure (CNKI). The epidemiological features of abdominal cocoon and its diagnosis and treatment were analyzed.

RESULTS: A total of 776 patients with abdominal cocoon were reported in China during the past 14 years. The male to female ratio was approximately 1:1.37. The mean age of patients at the time of their diagnosis was 29.3 years. Fifty-seven percent of the patients were distributed in East China. Intestinal obstruction of different types was the main clinical manifestation in 91.5% of the patients, diffuse abdominal cocoon was found in 68.3% of the patients, and greater omentum was absent in 40.5% of the patients. Capsule resection was the main procedure for the treatment of abdominal cocoon.

CONCLUSION: Abdominal cocoon is more common in East China and is difficult to diagnose before operation. Capsule removal and adhesion release are effective against the disease.

Case report: abdominal cocoon associated with tuberculous pelvic inflammatory disease

Abdominal cocoon is a rare acquired condition in which there is encapsulation of the small bowel by a fibrous membrane. The authors describe a case wherein an organism was identified for the first time. The clinical, pathological and radiological features of this unusual disease are reviewed. Peritoneal encapsulation, a related subject, is also discussed.

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.