Intestinal obstruction due to abdominal cocoon: CT findings

Sclerosing Encapsulating Peritonitis: Review

“…2,15 Biopsy results from surgical interventions may indicate SEP unexpectedly. [1][2][3][4][5]16,26,27 Li et al found that 52.3% of a large series of 65 SEP patients were diagnosed during surgery in contrast to 47.7% who were diagnosed preoperatively. 5 While the majority of SEP patients are asymptomatic, some symptoms may include nausea, vomiting, loss of appetite, weight loss and malnutrition as a consequence of acute, subacute or chronic episodes of complete or incomplete gastrointestinal obstruction.…”

“…[1][2][3][4][5][6]16,20,26 Radiological imaging can also support the diagnosis, starting with abdominal X-rays, barium studies and ultrasonography and progressing to abdominal computed tomography (CT) and, in occasional cases, contrast-enhanced magnetic resonance imaging (MRI). 11,12,17,24,27,[29][30][31][32] Abdominal X-ray findings are likely to be nonspecific and would indicate features of bowel obstruction, including dilated loops of the small intestine with multiple air fluid levels and, occasionally, bowel wall and peritoneal calcification [ Figure 3A]. 1,2,5,24,30 On the other hand, a barium study may show central clumping of the gut-often described as a cauliflower sign or accordion patternas a consequence of membrane encasing.…”

“…1,3,4 Contrast-enhanced CT is the most reliable investigative method to diagnose SEP; features include a central accumulation of the small intestine encased by a dense membrane with a contrast-free periphery [ Figure 3B]. [1][2][3]17,24,27,30 The presence of additional findings may further facilitate the diagnosis, including: intestinal obstruction; ascites; peritoneal or mesenteric thickening; thickening of the small bowel wall; a softtissue density mantle; calcification of the serosal bowel wall over the liver capsule, spleen or peritoneal wall; localised fluid collection; and lymphadenopathy. [1][2][3]17,24 Calcification often occurs around blood capillaries and may extend into the serosal and muscular layers; the presence of this feature is important as it could influence both the integrity of the gut and reflect the difficulty in dissecting the membrane from the bowel wall.…”

“…3 A multidetector CT scan with axial, sagittal and coronal reconstruction provides greater accuracy in detecting characteristic findings, excluding other differential diagnoses and facilitating the decision-making process with regards to surgical interventions. [1][2][3][4]17 As CT scans are relatively cheaper, more widely available and more reliable in detecting certain findings, they are the obvious choice for establishing a diagnosis of SEP. [1][2][3][4]17,24,27 Reportedly, CT scans are able to reveal characteristic findings of SEP including peritoneal thickening, loculated fluid collection, calcification, congregated small bowel loops in the centre of the abdomen and peritoneal enhancement, with sensitivity rates of 100%, 90%, 70%, 60% and 50%, respectively. 24 The role of MRI in the diagnosis of SEP is limited, although some research indicates that this modality may be marginally superior to CT imaging.…”

“…s u r g i c a l i n t e r v e n t i o n s Patients with severe symptoms of intestinal obstruction, those with virgin abdomens and those who do not respond to conservative management may be candidates for surgical interventions. [1][2][3][4][5][6][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]26,27,31,33,34 Surgical options include membrane excision plus adhesiolysis or, for patients with a gut injury, resection plus anastomosis with or without a protective enterostomy. An integral part of surgery is the complete excision of the membrane; this ensures a reduction in the recurrence rate.…”