Sclerosing Encapsulating Peritonitis Research Articles

A case report on cocoon abdomen

Abdominal Cocoon is one of the rare causes of intestinal obstruction. A complete or partial small bowel encapsulation caused by thick fibro collagenous membrane. Cocoon Abdomen is otherwise called Sclerosing Encapsulating Peritonitis (SEP). This SEP is divided into two: abdominal cocoon (AC) also known as idiopathic or primary sclerosing encapsulating peritonitis, which is extremely a rare and secondary sclerosing encapsulating peritonitis, which is a common one. Symptoms are nonspecific and preoperative diagnosis was extremely difficult. Surgery is very essential to take membrane samples that confirm diagnosis and for treatment.

IDIOPATIC SCLEROSING ENCAPSULATING PERITONITIS

ABSTRACT Introduction: Sclerosing Encapsulating Peritonitis (SEP) is a rare syndrome characterized by a chronic inflammatory process that leads to the formation of a thick fibrocollagenous membrane that surrounds and entraps intra-abdominal organs. As a result, although some cases may be asymptomatic, patients commonly develop symptoms of intestinal obstruction, and the diagnosis is often made incidentally during intra-abdominal surgeries. Case report: A 37-year-old male patient, a chronic alcoholic, was admitted with severe abdominal pain for seven days associated with abdominal distension, anorexia, and fever. Abdominal examination revealed signs of peritoneal irritation. Chest X-ray and abdominal computed tomography showed pneumoperitoneum and a large fluid collection, with signs of wall thickening extending through the pelvic cavity, parietocolic gutters, anterior abdominal cavity, and hepatodiaphragmatic space, causing compression of the hepatic parenchyma and displacement of intestinal loops. Due to these findings, the patient underwent an emergency exploratory laparotomy, in which a fibrocollagenous membrane, extensive bowel obstruction, and an abscess were identified. A total of 4.5 liters of purulent secretion were drained, the fibrous membrane was excised, the abdominal cavity was copiously washed, and a drain was placed in the upper right quadrant. He had a satisfactory resolution of the condition, without postoperative complications, and was discharged 11 days after the procedure. Conclusion: Initially, conservative management should be prioritized due to the technical difficulty of surgery and possible complications. However, in case of greater the level of peritoneal involvement and tissue adhesion, there is a higher chance of failure of conservative management, and surgical intervention may become necessary. Keywords: Peritonitis. Fibrosis Peritoneal. Intestinal Obstruction.

Sclerosing encapsulating peritonitis: a very rare disease entity in cats

Sclerosing encapsulating peritonitis (SEP), also known as encapsulating peritoneal sclerosis, is a very rare disease described in humans as well as in animals. This condition is characterized by a chronic, diffuse, fibrocollageneous thickening of parietal and visceral peritoneum with secondary encapsulation of abdominal organs, mostly small intestines. Etiopathogenesis remains incompletely understood. SEP can be divided into primary, idiopathic forms and secondary forms. Secondary SEP can be caused by many different underlying disorders of which peritoneal dialysis is the most common one in humans. Diagnosis of SEP remains difficult due to its vague clinical symptoms; therefore, a combination of medical imaging, surgery and histopathology is warranted. Treatment is challenging and the prognosis is variable, depending on the severity of the disease. A combination of surgery, medicinal therapy, nutritional support and treatment of underlying disorders is used. In this article, two feline cases of SEP are described, followed by a review of the literature.

Sclerosing Encapsulating Peritonitis: A Rare Cause of Bowel Obstruction.

Sclerosing encapsulating peritonitis (SEP), also referred to as abdominal cocoon syndrome, is a rare cause of bowel obstruction characterized by a thickened fibrous peritoneum that encapsulates the intestines. The exact etiology is idiopathic but may be associated with long-term peritoneal dialysis (PD). In the absence of risk factors for adhesive disease, preoperative diagnosis can be difficult and may require operative intervention or advanced imaging to diagnose. Thus, the inclusion of SEP in the differential diagnosis for bowel obstruction is essential for early detection. Existing literature is focused on renal disease as an origin, but it can be multifactorial. Here, we discuss a case of sclerosing encapsulating peritonitis in a patient without known risk factors.

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.

Sclerosing encapsulating peritonitis in a dog

Sclerosing encapsulating peritonitis (SEP) is a rare condition which consists of reactive fibrous tissue proliferation with mixed inflammatory infiltration within the abdominal cavity. The present report describes an additional case of SEP affecting a mixed-breed immature female dog presented with persistent vomiting, progressive weight loss, and ascites. Abdominal radiographic and ultrasonographic findings suggested abdominal neoformation resulting in gastric displacement, in addition ascitic fluid was evaluated and cytology showed large numbers of inflammatory effusion. An exploratory laparotomy was performed and were detected multiple thick peritoneal adhesions which restricted mobility of abdominal viscera. Biopsy specimens of these lesions were submitted for histopathological examination. Microscopically, the external serous surfaces of the abdominal organs were covered with dense fibrous connective tissue characterized by intense mature collagen deposition and moderate angiogenesis. The animal was euthanized due to poor prognosis and sent for necropsy. The clinical, imaging, gross and microscopic findings were compatible with SEP. Keywords: Neoformation; intestinal obstruction; peritoneal adhesions, chronic inflammation.

CHRONIC MYELOID LEUKEMIA IN A PATIENT WITH ABDOMINAL COCOON SYNDROME: A RARE CLINICAL PRESENTATION

Described for the rst time almost a century ago, Sclerosing Encapsulating Peritonitis (SEP) is characterized by development of membrane like structure around abdominal viscera, especially small bowel. It is a recognized, rare cause of intestinal obstruction. Though several malignancies have been described as risk factors for SEP, contribution of these are on the lower side and most of these are abdominal malignancies if not all. Association of leukemias or lymphomas with SEP could not be found in literature. Our patient is an 18-year-old boy, who presented with complaints of abdominal pain and vomiting. He was managed conservatively, and relevant blood investigations and imaging was done. Ultrasound of abdomen and subsequent Contrast Enhanced CT scan of abdomen conrmed SEP, whereas blood investigations conrmed diagnosis of Chronic Myeloid Leukemia. Chronic myeloid leukemia predominantly occurs in elderly males with mean age of 65 or more. CML in young patient is a rare occurrence, that coupled with occurrence of SEP makes this case unique.

Imaging Findings in Dogs and Cats With Presumptive Sclerosing Encapsulating Peritonitis.

This retrospective case series describes imaging findings in seven dogs and two cats with a presumptive diagnosis of sclerosing encapsulating peritonitis (SEP) between 2014 and 2021. Peritoneal effusion was present in all animal patients. Sonographically, echogenic fluid with or without echogenic intraperitoneal septations, gathered or corrugated bowel loops, and abdominal lymphadenomegaly were suggesting an inflammatory process and the presence of adhesions. Gathering of the bowel with abdominal distension and/or signs of intestinal obstruction were major findings on radiographs. Abdominal fat stranding was an additional finding in animals undergoing a CT examination. Previous surgery, pregnancy, and the presence of a perforating foreign body were potential predisposing causes in 4/9 animals. Peritonitis was septic in 4/9 animals. As SEP is a rare condition but life threatening, this detailed description of imaging findings in a short case series can be useful for a presumptive diagnosis and surgical planning.

Idiopathic Encapsulating Peritonitis as Unusual Cause of Bowel Obstruction Discovered Intraoperative: A Case Report

Idiopathic sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction that is characterized by total or patial encasement of the intestines by a fibrocollagenous coccon-like a membrane. Early clinical features of this condition are generally non-specific and are frequently not recognized until the patient develops signs of small bowel obstruction. We report the observation of an adult patient operated for an acute bowel obstruction, in which the diagnosis of sclerosing encapsulating peritonitis (SEP) was made intraoperative. A good understanding of SEP and a better awareness of its clinical, paraclinical and therapeutic findings may aid to establish better management of this rare condition.

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.

Case report of sclerosing encapsulating peritonitis secondary to tuberculosis

Sclerosing encapsulating peritonitis (SEP) is a visceral encapsulation syndrome of inflammatory origin, seen as an infrequent cause of intestinal obstruction in young patients. It is a condition characterised by complete encapsulation of small bowel loops by a fibrocollagenous membrane, leading to cocoon formation. Histologically, the membrane is composed mainly of organised fibrin, probably derived from the plasma exudation of peritoneal microvasculature. Clinical presentation is related to the development of altered gut motility, resulting in abdominal pain and features of intestinal obstruction. We here discussed about a young patient who presented with features of intestinal obstruction and diagnosed with SEP, secondary to abdominal tuberculosis and was then treated surgically. SEP as a cause of intestinal obstruction is a rare life threatening entity encountered in day to day practice. Definitive diagnosis of this condition is challenging in the pre-operative period and is usually missed and a high index of suspicion is required.

Cocoon abdomen: bowels in a web

Cocoon abdomen is a rare, idiopathic condition characterised by fibrous encapsulation of the bowel segments giving an appearance of a cocoon. The patient may present with variable and non-specific symptoms like abdominal pain, tenderness, vomiting and it sometimes even leads to intestinal obstruction. We hereby report a case of 54-year-old male who presented with symptoms of intestinal obstruction. Apart from the sparing of 60 mm of the resection margin at either ends, most of the segment was encased by the peritoneum giving a ‘spider-web’ appearance. On opening the intestinal segment, there were multiple areas of kinking of the wall with narrowing of the lumen in the areas of the ‘cocooning’. No obvious mass lesion was identified either on the mucosal aspect or in the mesentery. Microscopic examination revealed that multiple loops of small bowel were tethered together by a loose, oedematous fibrovascular membrane. Sclerosing encapsulating peritonitis (SEP) is an extremely rare clinical entity and was first described by Foo et al. in 1978,1 in an adolescent girl, which is reported to be the most common age group. Our case was found in a middle-aged male, which differs in both age group and sex of the common incidence of this entity. The aetiology of this condition remains unknown; however there have been cases where the patients have had a prior abdominal surgery, abdominal tuberculosis, liver transplant or recurrent peritonitis.2 1.Foo KT, Ng KC, Rauff A, et al. Unusual small intestinal obstruction in adolescent girls: The abdominal cocoon. Br J Surg 1978; 65: 427–30.2.Stanley MM, Reyes CV, Greenlee HB, et al. Peritoneal fibrosis in cirrhotics treated with peritoneovenous shunting for ascites. Digest Dis Sci 1996; 41: 571–7.

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

Sclerosing encapsulating peritonitis (SEP) is a rare cause of acute abdomen and can be easily misdiagnosed. Preoperative diagnosis of the SEP can be performed with preoperative imaging studies. We aimed to evaluate the clinical features of ileus cases who were diagnosed with primary or secondary SEP in the last five years. This retrospective cohort study evaluated the patients who were admitted with ileus or acute abdomen symptoms to the Emergency Department of Elazığ Training and Research Hospital and underwent surgery by the same surgical team of General Surgery Department between January 2014 and January 2019. Patients who were diagnosed with primary or secondary SEP were included. The demographic data, clinical presentation, whether the disease was primary or secondary, the treatment options performed and mortality rates were evaluated. SEP was observed in 11 of the patients. Ten patients underwent surgery (90.9%), and one patient (9.1%) was treated conservatively. Of the patients, six had secondary SEP (54.5%) and five had primary SEP (45.5%). In total, five patients were female (45.5%) and six were male (54.5%). The median age of the patients was 35 years (24-69). The median age of the patients with primary disease was 48 (29-69) years, while the median age of patients with secondary disease was 34.5 (24-64) years. One patient expired in the postoperative 8th hour. SEP should be considered in the case of recurrent abdominal pain attacks, especially in patients undergoing peritoneal dialysis, and it should be known that the mortality rate is high when misdiagnosed.

Sclerosing Encapsulating Peritonitis after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Description of 4 Cases

Background: Sclerosing encapsulating peritonitis (SEP) is a rare condition characterized by chronic inflammation of the peritoneum that leads to the formation of a fibrous tissue that encases the intra abdominal organs, especially the small bowel and/or colon. It usually presents with repetitive episodes of bowel obstruction. Association with cytoreductive surgery (CRS) + hyperthermic intraperitoneal chemotherapy (HIPEC) has been reported.

Abdominal Cocoon or Encapsulating Peritoneal Sclerosis: A Rare Cause of Small Bowel Obstruction.

Encapsulating peritoneal sclerosis (EPS), also known as abdominal cocoon syndrome (AC) or sclerosing encapsulating peritonitis (SEP), is an uncommon condition typically presenting with features of bowel obstruction. We present the case of a 41-year-old male patient who presented to the accident and emergency department with a 7-day history of abdominal pain. Contrast CT of the abdomen and pelvis was ordered and was suggestive of small bowel obstruction involving most of the small bowel with no apparent transition point. Laparotomy showed a tough whitish fibrous membrane encasing the entire length of the small bowel. Advances in CT have made diagnosis possible before a decision on surgical intervention is made.LEARNING POINTSDespite being a rare cause of bowel obstruction, based on the clinical presentation and CT findings, abdominal cocoon syndrome should be included in the differential diagnosis.CT of the abdomen is the investigation of choice for most cases of bowel obstruction and can be very helpful in reaching a diagnosis before operative management is undertaken.Laparotomy is the usual choice for management, but laparoscopy can be considered either to establish the diagnosis or to deal with the abdominal cocoon based on the surgeon’s clinical judgement and experience.

SCLEROSING ENCAPSULATING PERITONITIS (SEP) DUE TO MYCOBACTERIUM BOVIS

Sclerosing Encapsulating Peritonitis (SEP), a visceral encapsulation syndrome of inflammatory origin either primary or secondary based on causation, is an infrequent cause of mechanical bowel obstruction that may commonly be seen in young patients. Preoperative diagnosis is quite challenging and usually missed due to the non-specific nature of the clinical picture. In most of the cases, a definitive diagnosis is reached intra and postoperatively with histopathological and culture findings. Herein, we report a young male patient that presented to our emergency department with signs and symptoms suggestive of intestinal obstruction. Intraoperatively, a thin membrane encasing the small bowels with transmesenteric herniation noted with a clinical diagnosis of SEP as the primary cause of obstruction. Postoperatively, a definitive cause was identified by histopathological findings and specimen culture. The report of this case, as one of the few male patients with this entity in the published literature, highlights the notion that surgeons should be vigilant to keep in mind this extremely rare cause while managing a patient with intestinal obstruction.

Sclerosing encapsulating peritonitis caused by extensive endometriosis: A very rare entity

Sclerosing encapsulating peritonitis (SEP) is a very rare cause of intestinal obstruction in adults, due to total or partial encapsulation of the small bowel by a fibrocollagenous, cocoon-like membrane. SEP can be primary (idiopathic) or secondary. A 38-year-old nulliparous female who required recurrent paracentesis and laparotomies for intestinal obstruction and was diagnosed to have SEP with extensive endometriosis involving ovaries, peritoneum, mesentery, and appendix along with massive hemoserous ascites is reported here. Endometriosis is a very unusual cause of SEP.

Peritoneal encapsulation: A puzzling encounter during open and laparoscopic surgery

The presence of an intraperitoneal membrane, encasing parts of the bowel, is a bizarre and rare condition. Three categories are recognized, peritoneal encapsulation, primary sclerosing encapsulating peritonitis (SEP), and secondary SEP, each with different etiology. Symptomatic cases may present with bowel obstruction while asymptomatic cases may only be discovered at surgery for an unrelated reason. In this report, we describe the clinical course of two patients, in whom the condition was discovered only during surgery. The first patient had peritoneal encapsulation and the condition was discovered during laparoscopic cholecystectomy. Due to a bizarre laparoscopic view, in which access to the general peritoneal cavity was hindered by the membrane, conversion to open surgery was necessitated. The second patient had idiopathic encapsulating sclerosing peritonitis, which was discovered at laparotomy for bowel obstruction. Both patients convalesced well after surgery and had an unremarkable postoperative course. In this report, we aim to highlight the existence of this rare entity, which can cause difficulty, particularly during laparoscopic surgery.

Cocooning of the intestine: a case report and a brief review of the literature

Sclerosing encapsulating peritonitis (SEP) is a rare entity. There are well established secondary causes for this condition, but primary SEP is rare. This is a case report of SEP occurring in a 52- year-old female who is diabetic. She did not have any other risk factors for the development of this condition. Therefore she was diagnosed to have primary sclerosing encapsulating peritonitis.

Sclerosing encapsulating peritonitis as a potential complication of cytoreductive surgery and HIPEC: Clinical features and results of treatment in 4 patients

Sclerosing encapsulating peritonitis (SEP) is a rare entity characterized by encapsulation of the small bowel and/or the colon by a fibrous tissue that forms a shell. Intraperitoneal chemotherapy (IPC) has been reported to be a potential causative factor of secondary SEP. However, few studies have reported on secondary SEP related to cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Here, we review results from four clinical cases of SEP associated with CRS and HIPEC. In all four patients, additional surgery was necessary to alleviate recurrent episodes of small bowel obstruction. These obstructions can occur as early as several weeks after CRS plus HIPEC or as late as 3 years after treatment. Of utmost importance is the prevention of fistulization which can result in enteric contamination of the peritoneal space. To date, no solution to SEP has been identified except additional surgery but it is evident that these reoperative experiences are difficult for both surgeon and patient. The etiopathogenesis of SEP in this setting remains unknown but it is clear that it is related to chronic inflammation of the peritoneum. Large studies are needed to identify the incidence and potential common causes of SEP after CRS and HIPEC.