Surgical Outcomes in Patients with Abdominal Cocoon: Series of 15 Patients

Abstract

Background Abdominal cocoon (AC) or sclerosing encapsulating peritonitis is an uncommon cause of intestinal obstruction. Surgical intervention is warranted in patients with persistent pain or intestinal obstruction. Methodology A retrospective analysis of patients operated for AC was performed. Clinical presentation, radiological data, postoperative outcomes (Ryles tube (RT) removal, duration of hospital stay, enterocutaneous fistula, requirement for re-exploration and mortality) were retrieved and analyzed. Results Fifteen patients of abdominal cocoon required surgical intervention for various indications. The mean age was 34.46 years (13-60), and 11 (73.3%) were males. Intermittent abdominal pain was present in 14 (93.3%) followed by recurrent subacute intestinal obstruction (SAIO) in 11 (73.3%). Three patients presented with intestinal perforation. Of the 14 patients with preoperative computed tomography, radiological diagnosis was possible in five patients. The mean duration for surgery was 159 min (60-360 min). Membrane encasement was complete in 9/15 and partial in 6/15 patients. Adhesiolysis was done in all patients (complete-10/15 and partial-5/15). Mean duration for RT removal and hospital stay was 4.3 and 12.3 days, respectively. Recurrence of SAIO was observed in three patients, and one patient needed re-exploration for the same. One patient developed postoperative enterocutaneous fistula requiring surgical intervention. Overall mortality in the study was 13.3% (2/15). Four patients had underlying tuberculosis, and the rest were idiopathic. Conclusion Etiology of AC is not known in majority of patients. Persistent pain and recurrent SAIO are the most common indications for surgery. This morbidity associated with surgery can be reduced by meticulous dissection techniques and appropriate peri-operative care.Narender Dhaka: deceased now.

Abdominal Cocoon With Intestinal Perforation: A Case Report

“…The causes of abdominal cocoon can be divided into primary and secondary abdominal cocoon disease (9). Primary abdominal cocoon disease is majorly caused by embryo body curling, abnormal mesoderm differentiation, and intestinal dorsal mesenteric dysplasia during the embryonic period.…”

A Diagnostic Dilemma for Acute Abdomen: Sclerosing Encapsulating Peritonitis (Abdominal Cocoon Syndrome); A Retrospective Cohort Study

“…8 Any type of abdominal surgery may result in SEP, such as kidney transplantation, liver transplantation, and HIPEC. 13,17,18 Additionally intraabdominal granulomatous infections such as tuberculosis, pelvic inflammatory diseases, medical treatment for different cardiac disorders such as propranolol, and malignancies may lead to the secondary form of SEP. 4,[18][19][20][21][22] Although the incidence of ACS is not exactly known, the incidence and prevalence of secondary SEP are 0.7%-3.3% and 0.54%-7.3%, respectively, in patients with peritoneal dialysis catheter. 16,23 Our results show the clinical incidence for primary SEP at 0.46% and for secondary SEP at 0.55%.…”

“…Although the majority of the patients are diagnosed intraoperatively, as in our patients who underwent surgery, if the patient does not manifest the findings of acute abdomen, as in our 9th patient, they can be treated conservatively (with stopping oral intake, nasogastric decompression, total parenteral nutrition) and drugs (colchicine, steroids, immunosuppressive drugs such as azathioprine). 19 Medical treatment can be used to prevent encapsulation, especially in patients with peritoneal dialysis catheter who are at high risk for secondary SEP. 17 Additionally, as a result of tubercular abdominal infections, abdominal cocoon cases can be treated medically with antitubercular therapy. 19,21 In undiagnosed patients who develop acute abdomen, surgical treatment should be considered.…”

“…19 Medical treatment can be used to prevent encapsulation, especially in patients with peritoneal dialysis catheter who are at high risk for secondary SEP. 17 Additionally, as a result of tubercular abdominal infections, abdominal cocoon cases can be treated medically with antitubercular therapy. 19,21 In undiagnosed patients who develop acute abdomen, surgical treatment should be considered. In addition to the procedures performed via open surgery, laparoscopic surgery can also be used for surgical treatment.…”

Primary Abdominal Cocoon with Right Intra-Abdominal Cryptorchidism: A Case Report

“…At present, surgery should be the rst choice for abdominal cocoon with severe acute abdomen symptoms (9,16,17), the main principle is to separate and peel off the cocoon membrane, loose the adhesion between the intestines to release the movement vitality. The cocoon membrane may wrap the intestine and form the huge mass, which is easily misdiagnosed as the gastrointestinal tumor.…”