Abdominal Cocoon Research Articles

Bowel inflammatory presentations on computed tomography in adult patients with severe aplastic anemia during flared inflammatory episodes.

Patients with severe aplastic anemia (SAA) frequently present with inflammatory episodes, and during flared inflammatory episodes, hematopoietic function is further exacerbated. The gastrointestinal tract is the most common site for infectious and inflammatory diseases, and its structural and functional features confer on it the most potent capacity to affect hematopoietic and immune functions. Computed tomography (CT) is a readily accessible approach to provide highly useful information in detecting morphological changes and guiding further work-ups. To explore CT imaging presentations of gut inflammatory damage in adult SAA patients during inflammatory episodes. We retrospectively evaluated the abdominal CT imaging presentations of 17 hospitalized adult patients with SAA in search of the inflammatory niche when they presented with systemic inflammatory stress and exacerbated hematopoietic function. In this descriptive manuscript, the characteristic images that suggested the presence of gastrointestinal inflammatory damage and related imaging presentations of individual patients were enumerated, analyzed and described. All eligible patients with SAA had CT imaging abnormalities that suggested the presence of an impaired intestinal barrier and increased epithelial permeability. The inflammatory damages were concurrently present in the small intestine, the ileocecal region and the large intestines. Some readily identified imaging signs, such as bowel wall thickening with mural stratification ("water holo sign", "fat holo sign", intramural gas and subserosal pneumatosis) and mesenteric fat proliferation (fat stranding and "creeping fat sign"), fibrotic bowel wall thickening, "balloon sign", rugged colonic configuration, heterogeneity in the bowel wall texture, and adhered and clustered small bowel loop (including various patterns of "abdominal cocoon"), occurred at a high incidence, which suggested that the damaged gastrointestinal tract is a common inflammatory niche responsible for the systemic inflammatory stresses and the exacerbated hematopoietic failure in patients with SAA. Particularly, the "fat holo sign" was present in 7 patients, a rugged colonic configuration was present in 10 patients, the adhesive bowel loop was present in 15 patients, and extraintestinal manifestations suggestive of tuberculosis infections were present in 5 patients. According to the imaging features, a suggestive diagnosis of Crohn's disease was made in 5 patients, ulcerative colitis in 1 patient, chronic periappendiceal abscess in 1 patient, and tuberculosis infection in 5 patients. Other patients were diagnosed with chronic enteroclolitis with acutely aggravated inflammatory damage. Patients with SAA had CT imaging patterns that suggested the presence of active chronic inflammatory conditions and aggravated inflammatory damage during flared inflammatory episodes.

Abdominal Cocoon Syndrome (ACS) or Idiopathic Sclerosing Peritonitis: An Extremely Rare Cause of Intestinal Obstruction

Introduction: Abdominal cocoon syndrome is an extremely rare cause of intestinal obstruction in which loops of small bowel are encapsulated by a fibro-collagenous membrane. This condition is also known in the literature as sclerosing peritonitis, and in the majority of cases, it has no known cause. The majority of patients exhibit long-standing signs and symptoms of partial intestinal obstruction. Presentation of case: A 15-year-old female patient presented with complete intestinal obstruction with no known co-morbidity and no history of prior laparotomy. Intraoperatively, the entire small bowel was found to be encapsulated by a dense fibrous sac. The peritoneal sac was excised, followed by lysis of the inter-loop adhesions with appendicectomy done at the same time. Discussion: Most patients with abdominal cocoon syndrome present with features of recurrent acute or chronic small bowel obstruction secondary to kinking and/or compression of the intestines within the constricting cocoon. An abdominal mass may also be present due to an encapsulated cluster of dilated small bowel loops. Conclusions: Abdominal cocoon is a rare condition causing intestinal obstruction, and diagnosis requires a high index of suspicion because of the non-specific clinical picture. Contrast-enhanced CT-scan (CT) of the abdomen is a useful radiological tool to aid in preoperative diagnosis. Peritoneal sac excision and adhesiolysis is the treatment, and the outcome is usually satisfactory.

Steroid Responsive Abdominal Cocoon Syndrome Secondary To Peritoneal Dialysis; A Rare Case Presentation

Steroid Responsive Abdominal Cocoon Syndrome Secondary To Peritoneal Dialysis; A Rare Case Presentation

Agenesis of the greater omentum with primary abdominal cocoon: not an acquired condition

Agenesis of the greater omentum with primary abdominal cocoon: not an acquired condition

Abdominal Cocoon Syndrome, A Rare Case Report

A rare cause of intestinal obstruction is an abdominal cocoon. Preoperatively, most cases are difficult to diagnose. In most cases, surgical removal of the membrane resulted in complete recovery. The exact cause of abdominal cocoon is unknown. We described a male patient who presented with signs of intestinal obstruction and was diagnosed as having an abdominal cocoon intraoperatively.

A forensic case of abdominal cocoon syndrome.

The term "cocoon syndrome" defines a sclerosing encapsulating peritonitis (SEP) that involves a chronic fibrotic inflammatory reaction of the parietal peritoneum and of the viscera leading to a complete sclerosis. The cocoon that is formed causes an incarceration of the intestinal loops with severe complications leading to high mortality. We are presenting the case of a 15-year-old young man that underwent surgery for appendectomy and that was evaluated for having a regular abdominal state. During the post-surgery period, however, several episodes of intestinal occlusion required further surgical interventions leading to a right hemicolectomy. The presence of a fibrotic-adhesive ligneous peritonitis with blended intestinal loops, severely thickened walls, and intestinal scaring stenosis was observed during his second surgical operation. A stenosis of the colostomy led to a worsening of the vital signs of the young man with the onset of a cardiac failure and subsequent decease.Macroscopic autopsy examination and histological analysis confirmed the severe obstructive adhesive encapsulating abdominal context allowing to trace back the cause of death to a cocoon syndrome. Since no predisposing factor could be found, we hypothesized that this case could be characterized by an excessive peritoneal reactivity due to surgical appendectomy.Cocoon syndrome is a rare pathology, and its microscopic features are seldomly observed and could be underestimated. We present a directly observed case with a very substantial macroscopic and microscopic context.

A case report of encapsulating peritoneal sclerosis followed by cesarean section: Clinical diagnosis and treatment experience

Encapsulating peritoneal sclerosis (EPS), also known as abdominal cocoon syndrome, is an uncommon condition that typically presents with features of bowel obstruction. EPS followed by cesarean section is extremely rare. Intestinal obstruction caused by EPS lacks specificity and poses clinical difficulties for diagnosis and treatment. We present the case of a patient with recurrent intestinal obstruction followed by cesarean section, and the diagnosis of EPS was confirmed intraoperatively. The patient recovered well postoperatively, and achieved satisfactory therapeutic results. Management of this condition tests the surgeon's knowledge and experience of the disease. A 27-year-old woman with recurrent abdominal pain and distention accompanied by reduced anal discharge and defecation there months. The patient had a history of cesarean section 4 months earlier and recovered well after operation. She had no other history of abdominal surgery or diseases. On examination, a 10-cm long transverse incision was made in the lower abdomen, and marking on the intestinal movements were observed in the left mid-abdomen. A long, soft lump with good mobility was touched in the left lower abdomen. The abdominal computed tomography and small bowel barium meal examination revealed incomplete intestinal obstruction. Incomplete small bowel obstruction due to abdominal adhesions after the cesarean section was initially considered. After conservative treatment, the symptom of intestinal obstruction still recurred. Thus, we decided to perform a surgery of repeated decortication of fibrous peritoneal membranes. The operation successfully released the intestinal obstruction and abdominal pain, postoperative course recovered smoothly. After cesarean section could develop EPS. Intestinal obstruction caused by EPS lacks specificity and poses clinical difficulty in diagnosis and treatment. The management of this condition tests the surgeon's knowledge and experience, and surgery is an effective treatment measure.

EP-325 Congenital peritoneal encapsulation rare pathology for Acute intestinal Obstruction

Abstract Background Congenital peritoneal encapsulation (CPE) is a rare, congenital entity in which the small bowel is surrounded by an accessory peritoneal membrane. This condition is usually asymptomatic and rarely causes intestinal obstruction. This report highlights this rare congenital anomaly as a cause of intestinal obstruction. Case A 28-year-old fit man presented to A&E with classical features of intestinal obstruction. Abdominal CT scan showed features of mechanical small bowel with 360-degree rotated mesentery, and a suspicion of closed loop obstruction. An emergency laparotomy was performed. A large congenial peritoneal sac, wrapped the small bowel from D-J flexure to proximal part of ileum, and this sac was rotated 360 degrees with multiple adhesions and a single band to the left lateral wall. Early ischemic changes were noted, along with congested mesentery. The sac was opened, dissected and adhesiolysis was performed. The thick solitary band was released. There was immediate restoration of the blood supply and the bowel was viable. Patient recovered and discharged home on day 3 Discussion and conclusion Worldwide, only 50 cases on CPE have been published till date, with the maximum reported from the UK. The other common conditions that mimic CPE are internal paradodenal hernia, abdominal cocoon and sclerosing encapsulating peritonitis. Young patients with abdominal pain and feature of closed loop high small bowel obstruction on CT scan will need a high index of suspicion, before confirming the diagnosis. At this point, it will remain a rare occurrence and an incidental finding at laparotomy.

A Rare Cause of Recurrent Intestinal Obstruction: Abdominal Cocoon

A Rare Cause of Recurrent Intestinal Obstruction: Abdominal Cocoon

Neonatal abdominal cocoon arising from atypical sequelae of intestinal malrotation: A case report

Background: Abdominal cocoon (AC) is the partial or complete encasement of the intestines and sometimes other abdominal organs by a fibro-collagenous sac causing varied presentations of intestinal obstruction. It has been found in all age groups from neonates to the elderly although neonatal AC is quite rare and only very few cases have been reported. In neonates, the presentation could mimic other causes of partial or complete intestinal obstruction and preoperative diagnosis is usually difficult. Case Presentation: We report an atypical sequela of intestinal malrotation causing neonatal intestinal obstruction due to omental encasement of the small and large bowel. The diagnosis was made intraoperatively though contrast gastrointestinal series suggested the partial obstruction at the duodenal-jejunal level. The patient made a good postoperative recovery after extraction of the bowel from the cocoon (omental sac), partial omentectomy, and Ladd’s procedure. Conclusion: A neonatal abdominal cocoon caused by an omental encasement in a malrotated intestine is a unique presentation and a rare cause of neonatal intestinal obstruction.

Expression of Concern: Abdominal Cocoon: A Rare Complication of Peritoneal Dialysis in Chronic Kidney Disease.

Expression of Concern: Abdominal Cocoon: A Rare Complication of Peritoneal Dialysis in Chronic Kidney Disease.

Abdominal Cocoon Syndrome: A Rare Cause of Intestinal Obstruction

Abdominal cocoon syndrome, also known as Sclerosing Encapsulating Peritonitis, is characterized by a fibro-collagenous membrane that involves abdominal viscera and it’s a rare cause of intestinal obstruction.We present here two cases. Two male patients, 29 and 75 years old, were admitted to our emergency department with abdominal pain, vomiting, tender and painful abdomen but without changes in intestinal transit or peritoneal reaction. They were treated surgically and diagnosed with abdominal cocoon syndrome.Patients with abdominal cocoon syndrome usually present with recurrent episodes of intestinal obstruction, which result from the compression of the bowel within the constricting cocoon. Most of the time, this clinical picture resolves with conservative measures, delaying the diagnosis. The definitive treatment consists of excision of the membrane with lysis of adhesions, which is usually reserved for more severe cases of obstruction.This is a rare disease, where a high suspicion index is of paramount importance, especially considering that most of the diagnoses are made at the surgery.

A Rare Cause of Intestinal Obstruction: Case Report of an Abdominal Cocoon Syndrome in a Middle Aged Man from the Mediterranean Region

A Rare Cause of Intestinal Obstruction: Case Report of an Abdominal Cocoon Syndrome in a Middle Aged Man from the Mediterranean Region

A Rare Cause of Intestinal Obstruction: Case Report of an Abdominal Cocoon Syndrome in a Middle Aged Man from the Mediterranean Region

1.1. Introduction: Abdominal cocoon syndrome is a rare condition that refers to total or partial encapsulation of the small intestines leading to recurrent bowel obstruction. It usually affects young ladies from tropical and subtropical area. 1.2. Methods: we report a middle aged man, from the Mediterranean region, presenting with small bowel obstruction, with history of recurrent similar episode. 1.3. Results: after failure of conservative treatment, surgical exploration showed a thick fibrous peritoneal membrane wrapping the small bowel in a concentric fashion with some adhesions. The pathology of this resected fibrous membrane confirmed the diagnosis of an abdominal cocoon syndrome. 1.4. Conclusion: From the atypical presentation of our case, we can conclude that though rare, this condition must be kept in mind when considering the differential diagnosis of idiopathic intestinal obstruction in any adult and therefore the decision of a surgical exploration should not be differed in the appropriate context, especially in the light of the condition’s benign nature and favorable prognosis. 1.5. Background: Abdominal cocoon syndrome is a rare condition that refers to total or partial encapsulation of the small intestines by a fibro-collagenous membrane with local inflammatory infiltrate leading to acute, subacute or chronic bowel obstruction [1]. It also has been described as “encapsulating peritoneal sclerosis”, “sclerosing encapsulating peritonitis” and in Latin “peritonitis chronica fibrosaincapsulata” [1, 2]

Sclerosing Encapsulating Peritonitis after Living Donor Liver Transplantation

Sclerosing encapsulating peritonitis (SEP), or abdominal cocoon syndrome is a rare condition of unknown etiology in which intestinal obstruction results from encasement of variable lengths of bowel by a dense fibrocollagenous membrane. It is difficult to diagnose and the prognosis is poor.

A Rare Case Report of Idiopathic Abdominal Cocoon Presenting as Acute Intestinal Obstruction-Management Challenges

The idiopathic variant of sclerosing Intraperitoneal fibrosis is a rare pathological entity causing intestinal obstruction. Even though it is described since the beginning of the last century, we are still clueless about the aetiology of this problem. The presentation is often confusing and the clinical and laboratory values will be not confirmatory to establish a diagnosis. A Contrast-enhanced CT scan is a vital investigation of choice. Here we discuss a case of intestinal obstruction with a preop diagnosis of internal herniation, which turned out to be a case of massive intraperitoneal fibrosis. The histopathology was not significant, and no secondary cause was identified. The case report throws wisdom into the existence of this entity and how with a CT scan we can suspect it before surgery. With adequate and meticulous enterolysis we can surgically rehabilitate these patients so that they can lead a normal life.

Abdominal cocoon with eosinophilic infiltrate.

Abdominal cocoon with eosinophilic infiltrate.

Abdominal cocoon syndrome, a case report of a rare disease entity causing intestinal obstruction.

Introduction and importanceAbdominal cocoon syndrome is a rare condition characterized by small bowel encapsulation by a fibrous membrane or a cocoon-like sac. It is an uncommon cause of intestinal obstruction. Less than 300 cases have been reported from all over the world. This is the first case of such a disease entity to be reported from Sudan.Case presentationA young female patient, presented with features of intestinal obstruction that was managed conservatively. Failure of the conservative management has warranted a laparotomy.Clinical findings and investigationsHer features were suggestive of intestinal obstruction that was confirmed radiologically.Interventions and outcomeLaparotomy revealed a membrane-like fibrous material and extensive multiple loops adhesions, findings consistent with primary sclerosing encapsulating peritonitis (PSEP), also known as abdominal cocoon's disease. The membrane was excised and adhesiolysis was done. Intestinal obstruction was relieved after surgery and the patient showed good outcome.ConclusionsAbdominal cocoon syndrome is a rare cause of intestinal obstruction.Relevance and impactThe takeaway lesson from this case would be that the PSEP should be sought in any patient with no clear cause for obstruction can be identified. A contrast-enhanced CT scan is the diagnostic modality of choice. Finally, we think that the disease is underreported from Africa and more efforts should be carried out to increase patients' access to healthcare especially in rural areas with no access to hospitals in order to bring more cases to light. This case report has been reported in line with the SCARE Criteria (Agha et al., 2020 [17]).

PCC-002 - Severe Salmonella enteritidis infection complicated with colonic perforations and abdominal cocoon

PCC-002 - Severe Salmonella enteritidis infection complicated with colonic perforations and abdominal cocoon

An unusual case of intestinal obstruction due to abdominal cocoon: A case report.

Introduction and importanceAbdominal cocoon (AC) or Encapsulating Peritoneal Sclerosis (EPS) is a rare cause of bowel obstruction and due to non-specific presentation, it can be misdiagnosed and often mistreated.Case presentationWe present the case of 42 years male with a history suggestive of complete small bowel obstruction (SBO) without a history of pulmonary tuberculosis (TB) or peritoneal dialysis. CT imaging as well as the intraoperative finding of a cocoon membrane encasing the small bowel led to the diagnosis of abdominal cocoon.Clinical discussionAbdominal cocoon can be idiopathic or secondary to peritoneal dialysis, tuberculosis, or other rare causes. Patients usually present with features of SBO with varying severity. Diagnosis is aided by imaging investigations mainly CT scan and management is primarily surgical and usually involves adhesiolysis, total removal of the membrane with or without bowel loop resection.ConclusionDiagnosis of abdominal cocoon warrants awareness of the disease and a high index of suspicion of the treating clinician in patients with intestinal obstruction and an abdominal lump without a history of previous abdominal surgery. CT can guide diagnosis and early operative management seems to bear the best outcomes.