A Rare Cause of Intestinal Perforation in a Patient on Continuous Ambulatory Peritoneal Dialysis Therapy: Abdominal Cocoon Syndrome

Berhan Genç ,Seyhan Yalaz ,Atilla Çökmez ,Aynur Solak ,Emin Yilmaz

doi:10.7438/1584-9341-10-1-13

Abstract

Abdominal Cocoon Syndrome (ACS) or sclerosing encapsulating peritonitis is characterized by intestinal obstruction and ileus as a result of encasement of small intestines totally or partially by a thick fibrous sac. We herein present a patient undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD) therapy for chronic renal failure for 3 years who developed intestinal obstruction and perforation and was subsequently diagnosed with abdominal cocoon syndrome. Abdominal cocoon should be remembered in patients on CAPD therapy. One should also be aware that clinical signs of peritonitis may not become evident in the case of intestinal perforation in patients with ACS. In such cases, computed tomography has an important role in making the diagnosis.

Highlights

Abdominal cocoon or sclerosing encapsulating peritonitis is a rare cause of small intestinal obstruction caused by encasement of small intestines by a thick fibrotic capsule at varying lengths [1,2,3]
Many factors are held responsible from the secondary form, it is most commonly seen in patients with chronic renal failure undergoing continuous ambulatory peritoneal dialysis (CAPD) treatment [1]
Abdominal cocoon syndrome is seen in approximately 1% of patients on CAPD therapy; its prevalence increases with longer treatment duration and at 8th year it may be present in 20% of patients [16]

Summary

Introduction

Abdominal cocoon or sclerosing encapsulating peritonitis is a rare cause of small intestinal obstruction caused by encasement of small intestines by a thick fibrotic capsule at varying lengths [1,2,3]. We present a patient undergoing CAPD therapy for chronic renal failure for 3 years who developed intestinal obstruction and perforation and was subsequently diagnosed with ACS. His past history was remarkable for CAPD therapy for chronic renal failure for the last 3 years He began to undergo hemodialysis treatment owing to ineffective CAPD sessions for the past 2 months due to recurrent attacks of peritonitis. Other CT findings include ascites or loculated fluid collections, peritoneal thickening and contrast uptake, peritoneal calcification in patients with end-stage renal disease, intestinal mural thickening, and tethering or fixation of bowel loops. Omentum and intestinal loops freed after adhesiolysis (b) are seen

Discussion

Findings

Conclusion