An Idiopathic Case of Sclerosing Encapsulating Peritonitis: A Case Report

Sclerosing encapsulating peritonitis, also known as abdominal cocoon syndrome, is an uncommon disorder where a dense fibrous layer forms around the small intestine, causing blockage and vague abdominal complaints. Despite its infrequency, diagnosing and treating this condition is challenging due to its indistinct symptoms and the complex nature of its treatment. This report discusses a 55-year-old female with no notable medical history who experienced progressive abdominal pain and weight loss. Initial laboratory tests revealed mild normocytic anemia and raised levels of inflammatory markers. A computed tomography (CT) scan demonstrated "cocoon-like" encapsulation of the small intestines. After ruling out infectious, neoplastic, and autoimmune factors, the patient was diagnosed with idiopathic sclerosing encapsulating peritonitis. The treatment strategy began with conservative measures, including total parenteral nutrition and antibiotics, but eventually required surgical intervention due to ongoing symptoms. Postoperatively, the patient recovered well, showing significant symptom relief and weight gain at a six-month checkup. This case emphasizes the need to consider sclerosing encapsulating peritonitis when diagnosing unexplained abdominal symptoms, especially when no typical risk factors are present.

Primary Sclerosing Encapsulating Peritonitis (PSEP) With Meckel's Diverticulum: A Rare Case Report

Sclerosing encapsulating peritonitis (SEP) is a rare disease. Preoperative diagnosis of SEP can be made with imaging, such as computed tomography (CT). SEP is characterized by a partial or complete encasement of the small intestine by a layer of a thick grayish-white fibro collagenous membrane similar to an abdominal cocoon. The most common symptoms of SEP are abdominal pain, nausea, and vomiting. This rare disease often leads to acute or sub-acute intestinal obstruction. We discuss, in this report, how we managed a case of primary sclerosing encapsulating peritonitis with Meckel's diverticulum at our institution.

Sclerosing Encapsulating Peritonitis: Abdominal Cocoon

Sclerosing encapsulating peritonitis is a rare chronic inflammatory condition often with unknown origins. We report a case of an abdominal cocoon or sclerosing encapsulating peritonitis, which was suspected to be a result of bowel obstruction. Tuberculosis peritonitis was also suspected. However, the exact diagnosis was unclear, and it was diagnosed as an idiopathic abdominal cocoon. The patient's history is of clear relevance in this diagnosis, and this report will be of interest to clinicians attending to cases of bowel obstruction.

Stump pyometra in a spayed female dog secondary to tamoxifen

OBJECTIVE

To describe a complication associated with the long-term use of tamoxifen for the treatment of sclerosing encapsulating peritonitis in a dog.

CASE SUMMARY

A 2-year-old female spayed poodle cross was evaluated for a stump pyometra. The dog was diagnosed with sclerosing encapsulating peritonitis a year prior and was treated with tamoxifen, an oestrogen receptor antagonist, for treatment of the disease. The dog developed a swollen vulva with vulvar discharge and a stump pyometra was diagnosed on ultrasound. Hormonal testing was submitted to evaluate for an ovarian remnant and the dog underwent an exploratory laparotomy, where the uterine stump was removed. No ovarian remnant tissue was identified intra-operatively, and hormonal testing (anti-Müllerian hormone, progesterone, oestradiol) and histopathology were consistent with the absence of ovarian tissue. The tamoxifen was discontinued. The dog recovered uneventfully after surgery.

NEW OR UNIQUE INFORMATION PROVIDED

This report describes a complication of treatment of a rarely described clinical disease. While most cases of stump pyometra involve ovarian remnant syndrome, this case report describes a stump pyometra in a dog without remnant tissue that was undergoing treatment with tamoxifen. Tamoxifen has been reported to cause pyometra in intact female dogs. To the authors' knowledge, this is the first case report to describe a stump pyometra in a spayed female dog, secondary to the use of tamoxifen.

Tuberculous abdominal cocoon: A rare variant of peritonitis

Cocoon abdomen is an uncommon condition characterized by bowel entrapment in a cocoon‐like membrane. Its clinical presentation is usually non‐specific. Rarely, it may present with perforation peritonitis. The therapeutic approach depends on the stage of the disease. Surgery is essentially reserved for those with acute surgical complications.

Abdominal cocoon syndrome: Rare cause of intestinal obstruction-Case report and systematic review of literature

BACKGROUND

Abdominal cocoon or sclerosing encapsulating peritonitis is an uncommon condition in which the small bowel is completely or partially encased by a thick fibrotic membrane. Our study presents a case of sclerosing encapsulating peritonitis and conducts a literature review.

METHODS

A bibliographic research was conducted. Our research comprised 97 articles. Gender, age, symptoms, diagnostic procedures, and treatment were all included in the database of patient characteristics.

CASE PRESENTATION

A 51-year-old man complaining of a 2-day history of minor diffuse abdominal pain, loss of appetite, and constipation was presented in emergency department. Physical examination was indicative of intestinal obstruction. Laboratory tests were normal. Diffuse intraperitoneal fluid and dilated small intestinal loops were discovered on computed tomography (CT). An exploratory laparotomy was recommended, in which the sac membrane was removed and adhesiolysis was performed. He was discharged on the tenth postoperative day.

RESULTS

There were 240 cases of abdominal cocoon syndrome in total. In terms of gender, 151 of 240 (62.9%) were male and 89 of 240 (37%) were female. Ages between 20 and 40 are most affected. Symptoms include abdominal pain and obstruction signs. For the diagnosis of abdominal cocoon syndrome, CT may be the gold standard imaging method. The surgical operation was the treatment of choice in the vast majority of cases (96.7%). Only 69 of 239 patients (28.9%) were detected prior to surgery, and CT was applied in these cases.

CONCLUSION

Abdominal cocoon is a rare condition marked by recurrent episodes of intestinal obstruction. Surgical therapy is the most effective treatment option.

IgG4 related sclerosing encapsulating peritonitis with cocoon formation: An unusual and undescribed presentation

IgG4-related sclerosing mesenteritis is a rare disease of mesentery of an unknown etiology which shows a constellation of histopathologic findings of lymphoplasmacytic inflammation with IgG4-positive plasma cells and marked fibrosis. This chronic inflammatory condition of mesentery forming an abdominal cocoon has never been described before to the best of our knowledge. Here, we report a patient with a history of subacute small bowel obstruction who was found to have an intra-abdominal encapsulating mass in the right iliac fossa and was finally diagnosed as IgG4-related sclerosing encapsulating peritonitis (abdominal cocoon) based on peroperative findings, histology and immunohistochemistry.

Imaging Findings in Dogs and Cats With Presumptive Sclerosing Encapsulating Peritonitis

This retrospective case series describes imaging findings in seven dogs and two cats with a presumptive diagnosis of sclerosing encapsulating peritonitis (SEP) between 2014 and 2021. Peritoneal effusion was present in all animal patients. Sonographically, echogenic fluid with or without echogenic intraperitoneal septations, gathered or corrugated bowel loops, and abdominal lymphadenomegaly were suggesting an inflammatory process and the presence of adhesions. Gathering of the bowel with abdominal distension and/or signs of intestinal obstruction were major findings on radiographs. Abdominal fat stranding was an additional finding in animals undergoing a CT examination. Previous surgery, pregnancy, and the presence of a perforating foreign body were potential predisposing causes in 4/9 animals. Peritonitis was septic in 4/9 animals. As SEP is a rare condition but life threatening, this detailed description of imaging findings in a short case series can be useful for a presumptive diagnosis and surgical planning.

Sclerosing Encapsulating Peritonitis Following Recovery From COVID-19 Pneumonia

Coronavirus disease 2019 (COVID-19) is primarily a respiratory illness and pulmonary manifestations are the typical presentations of the disease. However, it became evident that the COVID-19 is not limited to the respiratory system. Specifically, gastrointestinal involvement in patients with COVID-19 is very common, particularly in patients with a critical illness. We present a case of a 52-year-old man who was diagnosed as having severe COVID-19 pneumonia and underwent endotracheal intubation and mechanical ventilation. The patient remained in the intensive care unit for seven days. Following his recovery, he started to experience generalized abdominal pain. The pain did not resolve with conservative measures. A computed tomography scan of the abdomen demonstrated small bowel loops clustered with a surrounding thin membrane. Such findings conferred the diagnosis of sclerosing encapsulating peritonitis. The patient was prepared for laparoscopic surgery. Resection of the membrane was performed without any injury to the encapsulated bowel. Analysis of peritoneal fluid by reverse transcription-polymerase chain reaction (RT-PCR) was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The patient had an uneventful recovery. Sclerosing encapsulating peritonitis is a very rare condition associated with COVID-19 pneumonia. The present case is the first reported case to document the presence of the SARS-CoV-2 virus in the peritoneal fluid in a patient with sclerosing encapsulating peritonitis.

Abdominal Cocoon Syndrome: A Laparoscopic Approach

Sclerosing encapsulating peritonitis, or abdominal cocoon syndrome (ACS), is a rare cause of intestinal obstruction in which the small bowel is encapsulated by a fibro-collagenous membrane. We present the case of a 29-year-old male who presented to us with acute intestinal obstruction. The imaging performed suggested the presence of ACS. The patient underwent laparoscopic adhesiolysis and the small bowel was released. In cases of recurrent small bowel obstruction, a high index of suspicion is required for the diagnosis of ACS. Computed tomography can be a useful imaging modality, and surgery remains the mainstay of treatment.

Sclerosing Encapsulating Peritonitis: A Rare Cause of Intestinal Obstruction

Sclerosing encapsulating peritonitis (SEP) is a rare clinical entity that may cause small bowel obstruction. It is characterized by a thick fibrocollagenous cocoon-like membrane. Surgical intervention is the mainstay of treatment. A 36-year-old Pakistani man presented with recurrent attacks of colicky abdominal pain, distention, vomiting, and constipation. Abdominal CT revealed a thick enhanced membrane forming a sac that contained clusters of small intestinal loops. Exploratory laparotomy showed a thick membrane containing the small bowel and extensive inter-loop adhesions. The sac underwent decortication and excision, inter-loop adhesions were released, and an appendectomy was performed. The patient tolerated the procedure and was discharged in good condition.

Difficult to Diagnose the Cause of Intestinal Obstruction due to Abdominal Cocoon Syndrome

Abdominal cocoon syndrome (sclerosing encapsulating peritonitis) is a rare condition associated with clinical signs of intestinal dysfunction, episodes of small bowel obstruction and sometimes a palpable abdominal mass. We present the case of a 46-year-old male patient with clinical signs of intestinal obstruction caused by primary sclerosing encapsulating peritonitis.

LEARNING POINTS

Abdominal cocoon syndrome is rare condition with repeated episodes of intestinal obstruction.Radiological investigations combined with a high index of suspicion are mandatory for establishing the diagnosis.Proper and timely diagnosis can lead to successful conservative treatment.

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 10th 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.

Sclerosing Encapsulating Carcinomatous Peritonitis: A Case Report

Sclerosing encapsulating peritonitis (SEP) is a rare clinical condition characterized by the formation of a thick, fibrous membrane encasing the intestines, which may lead to intestinal obstruction. The pathogenesis is not completely understood, but various risk factors are well established. However, there are only few reported cases of SEP associated with peritoneal carcinomatosis. Herein, we report a case of a 69-year-old male patient who presented clinically with acute intestinal obstruction 2 years after undergoing a resection procedure for gastric cancer. An abdominal computed tomography revealed findings typical of SEP. Consequently, the patient underwent exploratory laparoscopy, which confirmed the diagnosis of SEP and established the etiology as peritoneal metastases. The patient was managed conservatively, and his symptoms showed some improvement. The patient was at an advanced stage of the disease, and thus remained on palliative care and passed away 1 month later. Although very rare, physicians should consider SEP in their differential diagnoses of intestinal obstruction in patients, particularly in those with a history of intra-abdominal malignancies.

Abdominal Cocoon or Encapsulating Peritoneal Sclerosis: A Rare Cause of Small Bowel Obstruction

Encapsulating peritoneal sclerosis (EPS), also known as abdominal cocoon syndrome (AC) or sclerosing encapsulating peritonitis (SEP), is an uncommon condition typically presenting with features of bowel obstruction. We present the case of a 41-year-old male patient who presented to the accident and emergency department with a 7-day history of abdominal pain. Contrast CT of the abdomen and pelvis was ordered and was suggestive of small bowel obstruction involving most of the small bowel with no apparent transition point. Laparotomy showed a tough whitish fibrous membrane encasing the entire length of the small bowel. Advances in CT have made diagnosis possible before a decision on surgical intervention is made.

Secondary Abdominal Cocoon Syndrome Due To Chronic Beta-Blocker Use

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.

A rare case of intestinal obstruction: Sclerosing encapsulating peritonitis of unknown cause

Sclerosing encapsulating peritonitis (SEP) is characterized by the partial or complete enclosing of the small intestines by a thick fibro-collagenous membrane, which can cause recurrent intestinal obstruction. SEP is a clinically rare disease, and the major risk factor is peritoneal dialysis (PD). Early diagnosis of SEP is an important factor in the patient's prognosis, but it is clinically difficult. A 52-year-old woman visited the emergency department (ED) with a 2-day history of abdominal pain and vomiting. She had a history of liver cirrhosis with chronic hepatitis B, but no history of PD, and she underwent a biopsy of the peritoneum by laparoscopy a month ago. On physical examination, there were peritoneal irritation signs on the right lower quadrant (RLQ). Abdominal computed tomography (CT) showed dilated small intestinal loops clustered in the RLQ, which were surrounded by a sac-like, thick fibrous membrane. Based on CT findings, small intestinal obstruction due to SEP was early diagnosed in the ED. Emergency physicians should include SEP in the differential diagnosis of the cause of intestinal obstruction. Abdominal CT is a useful modality for the early diagnosis of SEP in the ED.

Secondary encapsulating peritonitis: a study of cases over five years

Objectives

Cocoon abdomen or sclerosing encapsulating peritonitis is a rare condition characterized by bowel entrapment in a cocoon-like membrane. Primary and secondary types have been described. Most patients present acutely with intestinal obstruction or peritonitis but history of long standing chronic symptoms may be present. The condition is usually not detected on imaging, and diagnosis at laparotomy is common. Surgical treatment includes excision of the membrane with adhesiolysis.

Material and Methods

A 5-year study of the patients operated for cocoon abdomen in our hospital was conducted. Analysis of patient symptoms, imaging findings, intra-operative findings and histopathology was carried out.

Results

Five males and three females were included into the study. Mean age was 29.6 years. Five patients presented with acute intestinal obstruction and three patients with perforation peritonitis. Laparotomy was performed in all cases. Successful excision of the membrane was done in all patients of obstruction while membrane excision could only be done in one patient of peritonitis. Histopathology revealed tuberculosis in six patients, one patient was already on anti-tubercular treatment and one patient had carcinoma. There was one mortality.

Conclusion

Cocoon abdomen is a rare condition. Tuberculosis should always be considered as a cause in endemic areas. Surgery is the preferred treatment and involves excision of the membrane but can be difficult in patients with superadded peritonitis or malignancy.

Pyloric outflow obstruction secondary to sclerosing encapsulating peritonitis in a dog

A 6-year-old, male neutered mixed breed dog was presented emergently with a three-week history of hyporexia, vomiting, diarrhoea and weight loss. Upon examination, the patient was dull, had generalised muscle atrophy, moderate abdominal pain and a mild amount of peritoneal effusion. A fluid-filled, distended, corrugated small bowel with marked gastroparesis and moderate peritoneal effusion was noted on abdominal ultrasonography. Endoscopy revealed hyperaemic and friable mucosa and a subjectively narrowed pylorus. Emergency exploratory celiotomy was performed due to worsening patient condition and revealed thick, diffuse, fibrous adhesions of the abdominal cavity. Based on these findings, sclerosing encapsulating peritonitis (SEP) was suspected. A large mass of omentum adjacent to the greater curvature of the stomach had caused a pyloric outflow obstruction. Adhesiolysis was attempted but was unsuccessful due to the friability of the small intestines. The dog was humanely euthanased under anaesthesia. A diagnosis of SEP was confirmed via necropsy. No underlying cause was identified. This is the first known case of a pyloric outflow obstruction secondary to SEP in a dog. Although rare, this condition should be considered as a differential for dogs with signs of a pyloric outflow obstruction with concurrent ascites and abdominal pain, hyporexia, vomiting and diarrhoea.

Abdominal cocoon with early postoperative small bowel obstruction: A case report and review of literature in China

RATIONALE

Abdominal cocoon is a condition in which intestinal obstruction results from the encasement of part or whole of the small bowel by a thick fibrous membrane, giving the appearance of a cocoon. The preoperative diagnosis is difficult to be made and the treatment is still controversial.

PATIENT CONCERNS

Here we describe the case of a 62-year-old male presented with a 24-h history of continual colicky abdominal pain, which was accompanied with nausea and vomiting.

DIAGNOSIS

Accurate diagnosis of abdominal cocoon was made intraoperatively.

INTERVENTIONS

Membrane excision and adhesiolysis were performed and the patient experienced early postoperative small bowel obstruction. Nasointestinal obstruction tube was then installed and bowel function was gradually recovered by the 20th postoperative day.

OUTCOMES

The patient recovered well and was discharged from the hospital on the 30th postoperative day LESSONS:: Abdominal cocoon can occur at any age. The possibility of abdominal cocoon should also be considered in infertile patients. Imaging studies may be helpful to make the correct diagnosis, and surgery should be performed for patients with recurrent acute or chronic intestinal obstruction.

Persistent ascites due to sclerosing encapsulating peritonitis mimicking ovarian carcinoma: A case report

Sclerosing encapsulating peritonitis, also known as 'Cocoon Syndrome', is a rare cause of bowel obstruction. The condition might be congenital or acquired and has non-specific symptomatology. Abdominal pain occurs due to the limitation of intestinal motility or segment obstruction by a thick homogenous fibrotic mantle covering the intra-peritoneal organs. Altered peritoneal fluid dynamics result in persistent ascites. Leading pathogenic theories are not well defined, but genetic factors, retrograde trans-tubal flow of causative agents, peritoneal infections, medications and peritoneal invasive procedures are all thought to play a role. There are no specific diagnostic criteria and exact diagnosis is only confirmed during surgery when the investing thick fibrous folds covering the bowel loops are visualised. We present here a case that had been suspected to have an ovarian malignancy due to a huge abdominal heterogeneous mass and ascites on preoperative diagnostic workup, but had a final diagnosis of abdominal Cocoon Syndrome made during surgery.

A problem encapsulated - role of CT

Sclerosing encapsulating peritonitis (SEP) is a rare but serious complication of abdominal surgery, recurrent peritonitis, and continuous ambulatory peritoneal dialysis with a high morbidity and mortality. The etiology of this condition is largely unknown. Diagnosis is usually established at laparotomy in patients with recurrent attacks of non-strangulating, small bowel obstruction. We report a case of a patient who presented with intestinal obstruction and who showed typical CT findings of SEP which was diagnosed pre-operatively on a CT scan and confirmed at surgery. The interest of this case lies in its rarity and difficult pre-operative diagnosis.

Sclerosing encapsulating peritonitis (abdominal cocoon) after abdominal hysterectomy

Sclerosing encapsulating peritonitis (SEP) is a poorly understood and rarely documented cause of small bowel obstruction. Although recurrent peritonitis has been reported as the main contributory factor leading to secondary SEP, the pathogenesis of primary (idiopathic) SEP is still uncertain. A 40-year-old woman with a history of total abdominal hysterectomy due to gestational trophoblastic disease presented with progressive lower abdominal pain and abdominal distension. Ultrasonography and contrast-enhanced abdomen-pelvis computed tomography of the abdomen revealed encapsulation of the entire small bowel with a sclerotic capsule. At laparotomy, a fibrous thick capsule encasing small bowel loops was revealed. Extensive adhesiolysis and removal of the capsule from the bowel loops were performed. The patient recovered uneventfully; she was discharged without complications. SEP is a rare cause of small bowel obstruction. We treated a case of abdominal cocoon with intestinal partial obstruction in a woman with a history of abdominal hysterectomy due to gestational trophoblastic disease. Surgical treatment was effective and the patient recovered without complication.

Clinical characteristics of dialysis related sclerosing encapsulating peritonitis: multi-center experience in Korea

Sclerosing encapsulating peritonitis (SEP) is a rare but serious complication in patients with continuous ambulatory peritoneal dialysis (CAPD), and is characterized by a progressive, intra-abdominal, inflammatory process resulting in the formation of sheets of new fibrous tissue, which cover, bind, and constrict the viscera, thereby compromising the motility of the bowel. No satisfactory estimate is available on the comparative incidence of dialysis related SEP and the pathogenesis of SEP still remains uncertain. Although recent therapeutic approaches have reported varying degrees of success, an efficient measure to detect, at an early stage, patients at risk for SEP would be beneficial and a standardized treatment regimen to prevent the illness is urgently needed. This study aimed to evaluate the clinical features of SEP and to identify the possible risk factors for the development of SEP in CAPD patients. We retrospectively reviewed by questionnaire SEP cases among CAPD patients from 7 university hospital dialysis centers in Korea, including Yonsei University, Ajou University, Catholic University, Inha University, Kyungpook University, Seoul National University and Soonchunhyang University, from January 1981 to December 2002. Out of a total of 4,290 CAPD patients in these centers, 34 cases developed SEP with an overall prevalence of 0.79%. The male to female ratio was 17:17. The median age of these patients was 44.5 years (range 19-66). The median duration of CAPD before SEP was 64 months (9-144) and 68% of patients (23/34) had been on CAPD for more than 4 years. Peritonitis (including two fungal cases) was the main cause of catheter removal in SEP (27 cases, 79%). Seventy-five percent of the cases (15/20) were administered beta-blocker for a mean duration of 85 months (26-130). Among 10 cases with available peritoneal equilibration test (PET) data, 8 showed high transporter characteristics, and the remaining 2 were high average. Eighteen cases were diagnosed by clinical and radiologic methods, and 16 were surgically diagnosed. Eleven cases were surgically treated and the others were treated conservatively with intermittent total parenteral nutrition (TPN). The overall mortality rate was 24%. SEP is a serious, life threatening complication of CAPD. Most cases had a PD duration of more than 4 years, a history of severe peritonitis, and high transporter characteristics in PET. Therefore, to reduce the incidence of SEP, careful monitoring and treatment, including early catheter removal in patients with severe peritonitis, should be considered for long-term CAPD patients with the above characteristics.