Abdominal cocoon with early postoperative small bowel obstruction

Xia, Jie; Xie, Wan‐Ying; Chen, Li; Liu, Daren

doi:10.1097/md.0000000000011102

Cited by 26 publications

(57 citation statements)

References 26 publications

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“…The cases not presenting obstruction could be managed by conservative methods. Such techniques include nasogastric decompression, proper nutritional support, and medications, like corticosteroids, tamoxifen, and azathioprine (6,8). Enterolysis surgery, however, remains the treatment of choice in acutely symptomatic cases and patients with failed medical management.…”

Section: Discussionmentioning

confidence: 99%

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Abdominal Cocoon Syndrome in a Child With Intestinal Obstruction: A Case Report and Literature Review

et al. 2020

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Abdominal cocoon syndrome or idiopathic Sclerosing Encapsulating Peritonitis (SEP) is an extremely uncommon cause of intestinal obstruction. Its etiology is explainable through numerous theories. An eleven-year-old girl referred to the pediatric surgery OPD with complaints of abdominal pain for the past two weeks and vomiting for two days. Her family history for tuberculosis was positive. On examination, the abdomen was distended and slightly firm on palpation. The X-ray of her abdomen revealed multiple air-fluid levels. The CECT of the abdomen indicated dilated abdomen, duodenum, and proximal bowel loops. Some trapped inter bowel free fluid was also observed. The clinical presentation of subacute intestinal obstruction and the radiological features suggested a differential diagnosis of tubercular peritonitis versus pseudomyxoma peritonei. The obstructive symptoms demonstrated that the patient underwent an explorative laparotomy. Preoperatively, a thin membranous sac was identified enclosing multiple dilated small bowel loops. The sac was released by blunt dissection and part of the sac was provided for histopathological examination. Based on clinical, histopathological, and radiological findings, a diagnosis of abdominal cocoon syndrome was determined. The postoperative follow-up period of 6 months was uneventful. We presented a rare case of primary sclerosing encapsulating peritonitis, also reported as abdominal cocoon syndrome. It is among the rare potentially devastating causes of intestinal obstruction in children. A very high index of suspicion is imperative to arrive at its pre-operative diagnosis alone by clinical and radiological findings.

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Section: Discussionmentioning

confidence: 99%

“…Idiopathic SEP has an excellent prognosis without reportable recurrences. The secondary forms of SEP, however, have a poorer outcome, compared to primary types (8). Recurrence is uncommon, although few patients present with adhesive intestinal obstruction in the view of the dissection, i.e., made during the surgical intervention (6).…”

Section: Discussionmentioning

confidence: 99%

Abdominal Cocoon Syndrome in a Child With Intestinal Obstruction: A Case Report and Literature Review

et al. 2020

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“…The incidence of acute abdominal pain in the current study was 100%. The main clinical manifestations included signs of bowel function and peritoneum physiological function disorder, and the fibrous sac also lead to bowel function disorder, decreased reabsorption and weakened enterokinesia, which caused nausea, vomiting, abdominal distension, the disappearance of bowel tone, abdominal pain, abdomen or pelvic masses, intestine obstruction, weight loss and blunt abdominal wall trauma-induced intra-cocoon bleeding (2,3,10,20). Peritoneal fibrosis lead to ascites by blocking the lymphatic vessels, which is a nonspecific symptom (21).…”

Section: Discussionmentioning

confidence: 99%

“…AC is a rare peritoneal disease, the pathogenesis of which remains to be determined. It is difficult to make a definite pre-operative diagnosis, thus AC is often misdiagnosed or omitted (2). Correct pre-operative diagnosis and early treatments may reduce complications, but also reduce mortality (2,3).…”

Section: Introductionmentioning

confidence: 99%

“…It is difficult to make a definite pre-operative diagnosis, thus AC is often misdiagnosed or omitted (2). Correct pre-operative diagnosis and early treatments may reduce complications, but also reduce mortality (2,3). Imaging examinations, especially CT, can facilitate pre-operative diagnosis, but few studies have discussed AC's imaging features and the diagnostic value of radiological imaging.…”

Section: Introductionmentioning

confidence: 99%

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Imaging and treatment of idiopathic abdominal cocoon in 9 patients

Rui

Yang

et al. 2019

Exp Ther Med

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The aim of the current study was to investigate the imaging features of abdominal cocoon (AC), the methods of diagnosis and treatment of AC and improve understanding of AC. To do this, the current study retrospectively analyzed the clinical data and imaging findings of nine patients with AC. The clinical manifestations included intestinal obstruction in six out of the nine cases of AC, which included two cases of bowel strangulation and five cases of soft masses in the abdomen. Imaging features of AC included the following: i) Bowel loops were usually present in a fixed cluster; ii) bowel loops were encapsulated partially or totally by a thickening fibrous membrane-like ‘cocoon’; iii) bowel wall thickened in the ‘cocoon’, and the bowel loops and sac adhered; iv) loculated ascites in the ‘cocoon’; v) abnormal clustering of the mesenteric vasculature, hypoplasia of the omentum majus was present or absent; and vi) Ileus occurred in some cases. The features of a plain abdominal X-ray, a gastrointestinal barium meal series and ultrasonography lacked specificity. The results of CT in eight out of nine cases of AC were consistent with the surgical findings. Surgery was the first choice of therapy. All cases were treated surgically, showing that the bowel loops were encapsulated partially or totally by a thickened fibrous membrane. All cases received operations including partial or total excision of the membrane and enterolysis. In conclusion, CT may be highly valuable in the preoperative diagnosis of AC.

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Primary abdominal cocoon syndrome manifesting with Chilaiditi syndrome and intestinal obstruction: A case report

Tajaddini,

Fallahi,

Haghshenas

et al. 2023

Clinical Case Reports

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Key Clinical MessageAbdominal 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.AbstractEncapsulating 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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Abdominal cocoon with early postoperative small bowel obstruction

Cited by 26 publications

References 26 publications

Abdominal Cocoon Syndrome in a Child With Intestinal Obstruction: A Case Report and Literature Review

Abdominal Cocoon Syndrome in a Child With Intestinal Obstruction: A Case Report and Literature Review

Imaging and treatment of idiopathic abdominal cocoon in 9 patients

Primary abdominal cocoon syndrome manifesting with Chilaiditi syndrome and intestinal obstruction: A case report

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