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Mahmood S, Srinivasan R, Berney C. Peritoneal encapsulation - An unusual cause of acute bowel obstruction: A case report. Int J Surg Case Rep 2024; 118:109616. [PMID: 38626638 PMCID: PMC11035026 DOI: 10.1016/j.ijscr.2024.109616] [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: 02/15/2024] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION/IMPORTANCE Peritoneal encapsulation (PE) is a rare congenital anomaly characterised by the presence of an accessory peritoneal membrane which encases part of the small bowel. Typically, this remains asymptomatic, however; in rare cases, a person may present with symptoms suggestive of a small bowel obstruction. CASE PRESENTATION Here we present a case of a 58 year old gentleman with congenital PE causing a bowel obstruction which was revealed on commuted tomography scan. He required a laparotomy and excision of the accessory sac. CLINICAL DISCUSSION Pre-operative diagnosis of PE can be challenging. It can present as a bowel obstruction with unique features including asymmetric distension of the abdomen on clinical exam and cocoon-like cluster of small bowel on imaging. CONCLUSION Congenital PE is a rare cause of bowel obstruction and should be considered early in patients presenting with symptoms of bowel obstruction without previous abdominal surgery.
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Vipudhamorn W, Juthasilaparut T, Sutharat P, Sanmee S, Supatrakul E. Abdominal cocoon syndrome-a rare culprit behind small bowel ischemia and obstruction: Three case reports. World J Gastrointest Surg 2024; 16:955-965. [PMID: 38577091 PMCID: PMC10989339 DOI: 10.4240/wjgs.v16.i3.955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/16/2023] [Accepted: 02/06/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Abdominal cocoon syndrome (ACS) represents a category within sclerosing encapsulating peritonitis, characterized by the encapsulation of internal organs with a fibrous, cocoon-like membrane of unknown origin, resulting in bowel obstruction and ischemia. Diagnosing this condition before surgery poses a challenge, often requiring confirmation during laparotomy. In this context, we depict three instances of ACS: One linked to intestinal obstruction, the second exclusively manifesting as intestinal ischemia without any obstruction, and the final case involving a discrepancy between the radiologist and the surgeon. CASE SUMMARY Three male patients, aged 53, 58, and 61 originating from Northern Thailand, arrived at our medical facility complaining of abdominal pain without any prior surgeries. Their vital signs remained stable during the assessment. The diagnosis of abdominal cocoon was confirmed through abdominal computed tomography (CT) before surgery. In the first case, the CT scan revealed capsules around the small bowel loops, showing no enhancement, along with mesenteric congestion affecting both small and large bowel loops, without a clear obstruction. The second case showed intestinal obstruction due to an encapsulated capsule on the CT scan. In the final case, a patient presented with recurring abdominal pain. Initially, the radiologist suspected enteritis as the cause after the CT scan. However, a detailed review led the surgeon to suspect encapsulating peritoneal sclerosis (ACS) and subsequently perform surgery. The surgical procedure involved complete removal of the encapsulating structure, resection of a portion of the small bowel, and end-to-end anastomosis. No complications occurred during surgery, and the patients had a smooth recovery after surgery, eventually discharged in good health. The histopathological examination of the fibrous membrane (cocoon) across all cases consistently revealed the presence of fibro-collagenous tissue, without any indications of malignancy. CONCLUSION Individuals diagnosed with abdominal cocoons commonly manifest vague symptoms of abdominal discomfort. An elevated degree of clinical suspicion, combined with the application of appropriate radiological evaluations, markedly improves the probability of identifying the abdominal cocoon before surgical intervention. In cases of complete bowel obstruction or ischemia, the established norm is the comprehensive removal of the peritoneal sac as part of standard care. Resection with intestinal anastomosis is advised solely when ischemia and gangrene have been confirmed.
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Affiliation(s)
- Witcha Vipudhamorn
- Department of Colorectal Surgery, Chiang Mai University, Chiang Mai 50200, Thailand
| | | | - Pawit Sutharat
- Department of Colorectal Surgery, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Suwan Sanmee
- Department of Colorectal Surgery, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Ekkarin Supatrakul
- Department of Colorectal Surgery, Chiang Mai University, Chiang Mai 50200, Thailand
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3
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Thomassen HK, Dolva MS, Schulz A, Fasting MH. Medfødt peritoneal innkapsling. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2024; 144:23-0564. [PMID: 38258706 DOI: 10.4045/tidsskr.23.0564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Affiliation(s)
| | - Merete S Dolva
- Avdeling for gastro- og barnekirurgi, Oslo Universitetssykehus, Ullevål
| | - Anselm Schulz
- Klinikk for radiologi og nukleærmedisin, Seksjon for onkologisk og abdominal radiologi, Oslo Universitetssykehus, Ullevål
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Tajaddini A, Fallahi M, Haghshenas H, Nourmohammadi S, Ghahramani L, Shahriarirad R. Primary abdominal cocoon syndrome manifesting with Chilaiditi syndrome and intestinal obstruction: A case report. Clin Case Rep 2024; 12:e8363. [PMID: 38161623 PMCID: PMC10753128 DOI: 10.1002/ccr3.8363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Abstract
Key Clinical Message Abdominal cocoon syndrome and Chilaiditi syndrome are rare etiologies of bowel obstruction which have to be considered in patients with obstructive symptoms. Patients can profit from surgical management rather than non-surgical approach. Abstract Encapsulating peritoneal sclerosis or abdominal cocoon syndrome (ACS) is an uncommon cause of intestinal obstructions associated with encapsulation of the small bowel by a fibro collagenous sac. Clinical presentations of ACS are unspecific and most patients are diagnosed intraoperatively. Moreover, Chilaiditi syndrome is another rare cause of bowel obstruction defined by interposition of colon and liver. There is no reported relation between these two conditions and surgical intervention is the suggested approach for severe bowel obstruction following them individually. We present a case with both conditions and describe our approach. A 47-year-old male presented with complaints of colic abdominal pain and distention, nausea and several attacks of bilious and nonbilious vomiting, anorexia, and constipation in the last 10 days before his admission. Laboratory data were normal and abdominal X-ray showed large dilation at the distal part of the bowel without air fluid level. The patient underwent explorative laparotomy and a mass-like lesion containing necrotic bowel and a whitish spleen accompanied by a complete anterior-rotated liver was found. The encapsulated bowel and the spleen were resected followed by the complete resolution of symptoms in the patient. The intestinal obstruction caused by ACS is mostly approached by surgery to prevent the fatal sequela of this condition.
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Affiliation(s)
- Ali Tajaddini
- Department of SurgeryShiraz University of Medical SciencesShirazIran
| | | | - Hoda Haghshenas
- Student Research CommitteeJahrom University of Medical SciencesJahromIran
| | | | - Leila Ghahramani
- Colorectal Research CenterShiraz University of Medical SciencesShirazIran
| | - Reza Shahriarirad
- School of MedicineShiraz University of Medical SciencesShirazIran
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical SciencesShirazIran
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Hajimirzaei SH, Abbasi M, Alamdari NM, Besharat S, Farsi Y, Gharib A, Seyyedi MS. Chronic constipation and acute small bowel obstruction due to small bowel encapsulation: A case report. Clin Case Rep 2023; 11:e8144. [PMID: 38046806 PMCID: PMC10689288 DOI: 10.1002/ccr3.8144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 12/05/2023] Open
Abstract
Key Clinical Message Peritoneal encapsulation is most of the time asymptomatic and is found incidentally, but when symptomatic it usually presents with bowel obstruction. CT scan is a gold standard for the diagnosis of bowel encapsulation. Abstract Congenital peritoneal encapsulation (CPE), abdominal cocoon syndrome (ACS), and sclerosing encapsulating peritonitis (SEP) are syndromes in which the small bowel is encapsulated. Small bowel encapsulation is usually asymptomatic and rarely presents with small bowel obstruction. In this article, we report a 65-year-old man who presented to our hospital with signs and symptoms of small bowel obstruction. He underwent an urgent operation, and small bowel encapsulation was diagnosed. One year after the surgery, all symptoms improved.
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Affiliation(s)
| | - Maryam Abbasi
- General Surgery DepartmentShahid Modarres HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Nasser Malekpour Alamdari
- Critical Care Quality Improvement Research CenterShahid Modarres HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Sara Besharat
- Department of RadiologyShahid Labbafinejad HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Yeganeh Farsi
- Critical Care Quality Improvement Research CenterShahid Modarres HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Atoosa Gharib
- Pathology DepartmentShahid Modarres HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Mahdiyeh Sadat Seyyedi
- General Surgery DepartmentShahid Modarres HospitalShahid Beheshti University of Medical SciencesTehranIran
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Ajibola OC, Shindang PJ, Ya’u GA. Congenital Peritoneal Encapsulation in A Pregnant Woman: A Case Report. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2023; 13:107-110. [PMID: 37538204 PMCID: PMC10395863 DOI: 10.4103/jwas.jwas_315_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/19/2023] [Indexed: 08/05/2023]
Abstract
Congenital peritoneal encapsulation (CPE) is a very rare congenital malformation of the gastro-intestinal tract which is characterised by the presence of an accessory peritoneal membrane in which the small bowel is contained and communicates with the rest of the peritoneal cavity by means of a small opening. We report a 26-year-old primigravida who presented with an acute onset abdominal pain and was found at laparotomy to have complications resulting from CPE. The embryological basis, clinical and pathological features of the disease are also considered. Knowledge of this condition will help guide the surgeon in making prompt decision when confronted with it.
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DALBAŞI E, GEDİK E. A Rare Cause of Small Bowel Obstruction- Congenital peritoneal encapsulation. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2023. [DOI: 10.33706/jemcr.1140912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Congenital peritoneal encapsulation (CPE) is a rare condition in which part or all of the small intestine is surrounded by an accessory peritoneal layer congenitally. Although it rarely causes small bowel obstruction, it is usually asymptomatic and the diagnosis is mostly made incidentally during surgery or autopsy. A 41-year-old male patient presented to the emergency department with diffuse and cramping pain lasting for approximately 8 hours. He had nausea and vomiting. No gas or faeces output for 72 hours. Abdominal computed tomography (CT) showed dilated abdominal small intestines and findings consistent with obstruction. The patient was hospitalized with the diagnosis of ileus. Decompression was performed with a nasogastric tube. It was decided to perform diagnostic laparoscopic surgery for the patient who did not respond to 24-hour observation and medical treatment. Laparoscopic examination revealed a thin membrane covering the small intestine from the terminal ileum to the middle of the jejunal segment on the right side of the abdomen. All adhesions were separated, the small intestines were released from the pressure of the accessory peritoneum and placed in the abdomen. The patient was discharged without complications on the 6th postoperative day. CPE should be considered in small bowel obstructions of unexplained etiology. Laparoscopic evaluation is effective in diagnosing CPE, but in cases where the long small bowel segment is affected, as in our case, we think that it would be appropriate to switch to open surgery to prevent morbidity, as well as the necessity of separating all bands
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Affiliation(s)
| | - Ercan GEDİK
- DICLE UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, DEPARTMENT OF GENERAL SURGERY
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Srisajjakul S, Prapaisilp P, Bangchokdee S. Imaging pearls and differential diagnosis of encapsulating peritoneal sclerosis: Emphasis on computed tomography. Clin Imaging 2023; 94:116-124. [PMID: 36527797 DOI: 10.1016/j.clinimag.2022.12.001] [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: 09/29/2022] [Revised: 11/20/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a severe peritoneal fibrotic reaction most frequently identified as a complication of peritoneal dialysis. EPS is a complex condition whose management requires multidisciplinary input from radiologists, gastroenterologists, nephrologists, surgeons, and dietitians. EPS carries significant morbidity and mortality, primarily due to bowel obstruction that results in intestinal failure, malnutrition, and sepsis. The nondialysis causes of EPS include tuberculous peritonitis, prior abdominal surgery, beta-blocker medication use, and endometriosis. The clinical symptoms of EPS are nausea, vomiting, and abdominal pain, all of which appear to be associated with bowel obstruction. The diagnosis of EPS needs three pillars to be met: clinical features, radiological evaluation, and histopathological analysis. The disease is frequently progressive and can be fatal. Computed tomography is the gold standard imaging modality for the detection of peritoneal abnormalities and encapsulation of bowel loops by thick adhesions or fibrosis (cocooning). Computed tomography also aids in making a differential diagnosis. Unfortunately, the diagnosis of EPS is often delayed because clinical findings are not specific and may resemble other peritoneal diseases. Radiologists should be familiar with the clinical impacts and related imaging features of EPS and realize when to seek them to facilitate timely and proper treatment.
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Affiliation(s)
- Sitthipong Srisajjakul
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Patcharin Prapaisilp
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Muacevic A, Adler JR, Shah A, Allu VJC. Congenital Peritoneal Encapsulation: A Literature Review of a Rare Pathology. Cureus 2022; 14:e31765. [PMID: 36569734 PMCID: PMC9772582 DOI: 10.7759/cureus.31765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 11/23/2022] Open
Abstract
Congenital peritoneal encapsulation (CPE) is a rare, congenital entity in which an accessory peritoneal membrane surrounds the small bowel. This condition is usually asymptomatic and rarely causes intestinal obstruction. Despite the rare cause of intestinal obstruction, it has excellent post-operative recovery. There is no gold standard approach for investigating CPE; however, a computerized tomography scan of the abdomen might be helpful. Furthermore, diagnostic laparoscopy could be considered an adjunct. This report highlights the rare congenital anomaly as a cause of intestinal obstruction.
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Davis R, Stahlfeld K, Sell HW. Congenital peritoneal encapsulation and superior mesenteric vein thrombosis: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221132436. [PMID: 36274860 PMCID: PMC9580079 DOI: 10.1177/2050313x221132436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Abstract
Congenital peritoneal encapsulation is a rare entity characterized by an accessory peritoneal membrane that forms during embryonic development. Congenital peritoneal encapsulation is generally asymptomatic but can cause intermittent, colicky abdominal pain related to subacute small bowel obstruction. Diagnosis is made incidentally or upon surgical exploration for chronic abdominal complaints as preoperative imaging is typically nonspecific. We report a case of a 49-year-old male with epigastric abdominal pain, constipation, and superior mesenteric vein thrombosis on imaging. Upon exploratory laparotomy, the small bowel was covered by an accessory peritoneal sac consistent with congenital peritoneal encapsulation. The accessory sac was excised completely, and the patient recovered well. Although rarely causing significant gastrointestinal symptoms, congenital peritoneal encapsulation is an anomaly that requires surgical intervention.
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Affiliation(s)
- Renee Davis
- Renee Davis, Department of Surgery, UPMC Mercy, 1400 Locust Street, Suite 6511, Pittsburgh, PA 15219, USA.
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11
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Alsadery HA, Busbait S, AlBlowi A, Alsawidan M, AlBisher HM, Alshammary S. Abdominal cocoon syndrome (idiopathic sclerosing encapsulating peritonitis): An extremely rare cause of small bowel obstruction-Two case reports and a review of literature. Front Med (Lausanne) 2022; 9:1003775. [PMID: 36314018 PMCID: PMC9596802 DOI: 10.3389/fmed.2022.1003775] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction 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 [1,2]. SEP is divided into two entities: abdominal cocoons (AC), also known as idiopathic or primary sclerosing encapsulating peritonitis, which is of extremely rare type, and secondary sclerosing encapsulating peritonitis, which is the more common type. Case presentation Two male patients from India, a 26 year old and a 36 year old, presented to our hospital complaining about abdominal pain associated with nausea and vomiting without any history of previous surgical interventions; the patients' vitals were stable. Preoperative diagnosis of abdominal cocoon was established by abdominal computed tomography. It showed multiple dilated fluid-filled small bowel loops in the center of the abdominal cavity with thin soft tissue, non-enhancing capsules encasing the small bowel loops with mesenteric congestion involving small and large bowel loops. Both patients underwent complete surgical excision of the sac without intraoperative complications. Patients had a smooth postoperative hospital course and were discharged home in good conditions. Conclusion Patients with abdominal cocoons have a non-specific clinical presentation of intestinal obstruction. A high index of clinical suspicion in combination with the appropriate radiological investigation will increase the chance of preoperative detection of the abdominal cocoon. In patients with complete bowel obstruction, complete excision of the peritoneal sac is the standard of care.
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12
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A Case of Peritoneal Encapsulation Presented as Acute Mechanical Small Bowel Obstruction: A Case Report and a Brief Literature Review. Case Rep Surg 2022; 2022:7851130. [PMID: 35992022 PMCID: PMC9388264 DOI: 10.1155/2022/7851130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/15/2022] [Indexed: 01/17/2023] Open
Abstract
Peritoneal encapsulation (PE) is a rare congenital malformation in which the small intestine is partially or totally encased in a supplementary peritoneal sac. PE is usually asymptomatic; therefore, it is one of the rarest etiologies of bowel obstruction. Our patient presented at the age of 55 with no prior surgical history and a 3-day history of abdominal pain associated with nausea, vomiting, belching, and constipation. An obstruction secondary to an internal hernia—visualized on a CT scan—was suspected as the initial etiology. On exploratory laparotomy, the small bowel was covered by a thick adherent sac. These findings are consistent with PE, a condition that deserves recognition among clinicians worldwide. Intraoperatively, the sac was excised, and the small bowel was pulled up to the peritoneal cavity starting from the ileocecal valve to the duodenojejunal junction. In the postoperative period, the patient was managed with intravenous fluids, analgesics, and antibiotics. Wound infection was the only postoperative complication. Otherwise, all symptoms subsided, and the patient improved and was discharged home on the 8th postoperative day.
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Deng P, Xiong LX, He P, Hu JH, Zou QX, Le SL, Wen SL. Surgical timing for primary encapsulating peritoneal sclerosis: A case report and review of literature. World J Gastrointest Surg 2022; 14:352-361. [PMID: 35664367 PMCID: PMC9131833 DOI: 10.4240/wjgs.v14.i4.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/06/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary encapsulating peritoneal sclerosis (EPS) is a rare but devastating disease that causes fibrocollagenous cocoon-like encapsulation of the bowel, resulting in bowel obstruction. The pathogenesis, prevention, and treatment strategies of EPS remain unclear so far. Since most patients are diagnosed during exploratory laparotomy, for the non-surgically diagnosed patients with primary EPS, the surgical timing is also uncertain. CASE SUMMARY A 44-year-old female patient was referred to our center on September 6, 2021, with complaints of abdominal distention and bilious vomiting for 2 d. Physical examination revealed that the vital signs were stable, and the abdomen was slightly distended. Computerized tomography scan showed a conglomerate of multiple intestinal loops encapsulated in a thick sac-like membrane, which was surrounded by abdominal ascites. The patient was diagnosed with idiopathic EPS. Recovery was observed after abdominal paracentesis, and the patient was discharged on September 13 after the resumption of a normal diet. This case raised a question: When should an exploratory laparotomy be performed on patients who are non-surgically diagnosed with EPS. As a result, we conducted a review of the literature on the clinical manifestations, intraoperative findings, surgical methods, and therapeutic effects of EPS. CONCLUSION Recurrent intestinal obstructions and abdominal mass combined with the imaging of encapsulated bowel are helpful in diagnosing idiopathic EPS. Small intestinal resection should be avoided.
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Affiliation(s)
- Peng Deng
- Department of General Surgery, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
| | - Long-Xin Xiong
- Department of General Surgery, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
| | - Ping He
- Department of General Surgery, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
| | - Jian-Hua Hu
- Department of Emergency Surgery, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
| | - Qi-Xu Zou
- Department of General Surgery, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
| | - Shi-Lian Le
- Department of General Surgery, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
| | - Sen-Lin Wen
- Department of General Surgery, The First Hospital of Nanchang, Nanchang 330008, Jiangxi Province, China
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Hu XH, Guo GL, Cao CL, Wang GY. Potential role of congenital peritoneal encapsulation in preventing peritoneal metastasis of sigmoid colon cancer: A rare case report. Asian J Surg 2021; 45:551-553. [PMID: 34649797 DOI: 10.1016/j.asjsur.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 11/02/2022] Open
Affiliation(s)
- Xu-Hua Hu
- The Second General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
| | - Gan-Lin Guo
- The Second General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
| | - Cui-Li Cao
- The Department of Anatomy, Hebei Medical University, Shijiazhuang, 050017, China.
| | - Gui-Ying Wang
- The Second General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, China; The Department of Gastrointestinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
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15
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Mathew KG, Akhtar S, Pius SI. Abdominal cocoon: precipitated by laparoscopic gas insufflation. BMJ Case Rep 2021; 14:e240024. [PMID: 33811094 PMCID: PMC8023630 DOI: 10.1136/bcr-2020-240024] [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] [Accepted: 02/27/2021] [Indexed: 11/04/2022] Open
Abstract
A young male in his early 30s presented to us with increasing swelling at the umbilicus, and an umbilical hernia was diagnosed. At laparoscopic intraperitoneal onlay mesh (IPOM) repair, an unexpected finding of a thin innocuous-looking fibrous film over the small bowel was noted. This finding presented a dilemma as to the probable pathology of this material, and a decision had to be made on whether laparoscopic IPOM could be continued. It was prudently decided to abandon the plan of placing a mesh intraperitoneally and an open repair of the umbilical hernia was done. In retrospect this was a wise decision, as, after 7 months he had to have a laparotomy for intestinal obstruction, when the classic thick fibrous encapsulating abdominal cocoon was seen. Hence here we have followed the evolution of the abdominal cocoon from its original asymptomatic phase to the classic encapsulating sclerosing peritonitis with probably laparoscopic gas insufflation being the precipitating factor.
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16
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Tojal A, Marques J, Coelho S, Ferreira MJ, Carrilho N, Horta-Oliveira A, Casimiro C. Congenital peritoneal encapsulation-a rare entity presented with small bowel obstruction. J Surg Case Rep 2021; 2021:rjaa601. [PMID: 33542816 PMCID: PMC7850068 DOI: 10.1093/jscr/rjaa601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 01/02/2023] Open
Abstract
Congenital peritoneal encapsulation is a rare congenital malformation in which all or part of the small bowel is covered by a thin accessory peritoneal membrane. Despite being usually asymptomatic and an incidental finding during surgery or autopsy, there is a small number of reports in the literature whose diagnosis was established in the context of intestinal obstruction. The authors review the topic and describe a case report undergoing surgery for intestinal obstruction. Intraoperatively, there was a partial peritoneal encapsulation of the small bowel with signs of intestinal malrotation. Peritoneal membrane excision, terminal ileum release and complementary appendicectomy were performed. There was a favorable clinical evolution in the postoperative period. Although rare, it is important to remember this entity in the differential diagnosis of patients with intestinal obstruction, in the absence of other etiologic factors.
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Affiliation(s)
- André Tojal
- Department of General Surgery, Centro Hospitalar Tondela-Viseu, E.P.E., Av. Rei D. Duarte, Viseu, Portugal
| | - Júlio Marques
- Department of General Surgery, Centro Hospitalar Tondela-Viseu, E.P.E., Av. Rei D. Duarte, Viseu, Portugal
| | - Sandra Coelho
- Department of General Surgery, Centro Hospitalar Tondela-Viseu, E.P.E., Av. Rei D. Duarte, Viseu, Portugal
| | - Maria-João Ferreira
- Department of General Surgery, Centro Hospitalar Tondela-Viseu, E.P.E., Av. Rei D. Duarte, Viseu, Portugal
| | - Noel Carrilho
- Department of General Surgery, Centro Hospitalar Tondela-Viseu, E.P.E., Av. Rei D. Duarte, Viseu, Portugal
| | - António Horta-Oliveira
- Department of General Surgery, Centro Hospitalar Tondela-Viseu, E.P.E., Av. Rei D. Duarte, Viseu, Portugal
| | - Carlos Casimiro
- Department of General Surgery, Centro Hospitalar Tondela-Viseu, E.P.E., Av. Rei D. Duarte, Viseu, Portugal
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Mohamed AAA, Al Shuraiqi FM, Al Sarhani S, Al Busaidi SAS, Joodi AA. Congenital peritoneal encapsulation presented with small bowel obstruction. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00287-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Abstract
Background
Congenital peritoneal encapsulation is an extremely rare condition with an etiology based on abnormal embryonic gastrointestinal development. It is characterized by congenital development of an accessory peritoneal layer partially or entirely encapsulating the small bowel. The condition is poorly understood and often discovered incidentally, either intra-operatively or during autopsy. The majority of cases are asymptomatic and rarely complicated by small bowel obstruction. The preoperative diagnosis may be impossible by plain radiographs, which are often normal or may show signs of small bowel obstruction. Computed tomography (CT) may be helpful in preoperative diagnosis of congenital peritoneal encapsulation in a patient with obstruction.
Case presentation
We report a case of a 46-year-old male patient, who presented with features of intestinal obstruction; surprisingly, CT accurately suggested the diagnosis of peritoneal encapsulation which was confirmed at surgery.
Conclusions
The presence of physical signs such as asymmetrical and fixed abdominal distension can help the clinician to raise the suspicion of peritoneal encapsulation; however, CT in the right settings can confirm the diagnosis.
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Asotibe JC, Zargar P, Achebe I, Mba B, Kotwal V. Secondary Abdominal Cocoon Syndrome Due To Chronic Beta-Blocker Use. Cureus 2020; 12:e10509. [PMID: 33094050 PMCID: PMC7571602 DOI: 10.7759/cureus.10509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Sclerosing encapsulating peritonitis (SEP), which is interchangeably used with the term ‘’abdominal cocoon syndrome’’, is a rare condition characterized by a thick fibrous membrane encasing portions of the intestinal wall leading to recurrent bowel obstructions. To date, literature describing the association between this condition and chronic beta-blocker therapy is scarce. This report adds by detailing a rare presentation of SEP and highlights an understudied yet important association of SEP with chronic beta-blocker therapy.
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Affiliation(s)
| | - Pejman Zargar
- Gastroenterology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Ikechukwu Achebe
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Benjamin Mba
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Vikram Kotwal
- Gastroenterology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
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