The diagnosis and treatment of abdominal cocoon in 8 cases / 中华普通外科杂志

Objective:To evaluate the diagnosis and treatment of abdominal cocoon.Methods:The clinical data of 8 patients with abdominal cocoon in our hospital from Jan 2015 to Dec 2021 were retrospectively reviewed including clinical and imaging manifestations, treatment and follow-up.Results:One case was asymptomatic, and the other 7 cases suffered from recurrent abdominal pain with complete or incomplete intestinal obstruction. The median course of disease was 6 months (15 days to 40 years). Six cases underwent laparcoscopic cocoon membrane resection and intestinal adhesion lysis, of which 2 cases underwent laparotomy, one case was converted to open surgery, 4 cases underwent concomitant appendectomy. Follow-up ranged from 3 to 69 months, there were 2 cases complicating early inflammatory intestinal obstruction, 1 case suffred wound fat liquefaction and infection, 1 case with a colic 5 months after operation, and the others were doing well.Conclusions:The clinical characteristics of abdominal cocoon disease are not typical. Surgery is the main treatment. The prognosis of the disease is generally fair.

IgG4 related sclerosing encapsulating peritonitis with cocoon formation: An unusual and undescribed presentation

IgG4-related sclerosing mesenteritis is a rare disease of mesentery of an unknown etiology which shows a constellation of histopathologic findings of lymphoplasmacytic inflammation with IgG4-positive plasma cells and marked fibrosis. This chronic inflammatory condition of mesentery forming an abdominal cocoon has never been described before to the best of our knowledge. Here, we report a patient with a history of subacute small bowel obstruction who was found to have an intra-abdominal encapsulating mass in the right iliac fossa and was finally diagnosed as IgG4-related sclerosing encapsulating peritonitis (abdominal cocoon) based on peroperative findings, histology and immunohistochemistry.

An Unusual Cause of Intestinal Obstruction: Abdominal Cocoon

ABSTRACT Abdominal cocoon syndrome is a rare cause of intestinal obstruction, which is difficult to diag- nose preoperatively. We here report a case of abdominal cocoon. A 47-year-old male patient was referred to the general surgery department with complaints of abdominal pain, distension, nausea and vomiting for 1 day. An abdominal computed tomography examination detected the dilated small intestinal loops clustered in the abdomen and surrounded by a sac-like membrane. During the exploratory surgery, a capsular structure was identified in the lower quadrant with a regular surface that was solid fibrous in nature. The combination of physical examination, imaging signs and medical history may be helpful in the diagnosis.

Surgical management of abdominal tuberculosis in a tertiary care referral center

Background: Abdominal tuberculosis encompasses gastrointestinal, visceral and peritoneal forms of tuberculosis in different proportions. Their clinical presentation and radiological findings are varied and non-specific often warranting surgical intervention either for confirmation of diagnosis or for definitive management.  It is not very clear as of now as to which type of patients would require surgical intervention for diagnosis or treatment of abdominal tuberculosis. This study aims to profile such patients accurately to revalidate the need for surgical intervention in cases of abdominal tuberculosis.Methods: This study is a retrospective descriptive observational study wherein the documents of patients whose final diagnosis was confirmed as ‘Abdominal Tuberculosis’ from January 2011 to December 2013 were analysed. Their demographic and clinical profile, hematological, biochemical and radiological investigations including barium meal follow-through, ultrasonography, CT scan abdomen, colonoscopy and biopsy, HIV status and ascitic fluid analysis were analysed. Patients in whom diagnosis was not confirmed by these investigations, and therefore underwent diagnostic laparoscopy or exploratory laparotomy were studied. Simultaneously, patients in whom, the diagnosis was confirmed, but still underwent surgical intervention for therapeutic purposes were also analysed.Results: It was found that 44 out of 54 patients (81.4%) underwent surgical procedure.  28 (52%) required surgical intervention for confirmation of diagnosis (diagnostic procedures: diagnostic laparoscopy- 21 and exploratory laparotomy- 07) while 16 (29.4%) required therapeutic procedures (emergency- 08; elective- 08).Conclusions: In spite of extensive investigations, many patients of abdominal tuberculosis require surgical management either minimally invasive or otherwise, both for confirmation of diagnosis and for definitive management.

Idiopathic abdominal cocoon: An enigma

Abdominal cocoon is often described by various terminologies like encapsulating peritoneal sclerosis (EPS) or sclerosing encapsulating peritonitis or peritonitis chronica fibrosa incapsulata is defined as syndromes associated with symptoms due to formation of a fibro-collagenous peritoneal membrane involving commonly the small intestinal loop. Clinical presentation ranges from abdominal pain to features of intestinal obstruction which may be acute or sub-acute. It is believed to be mesenchymal transition of mesothelial cells. This condition is commonly associated with tuberculosis, peritoneal dialysis and previous abdominal surgeries but may also be idiopathic. Though a wide range of medical management has been tried for conservative management of the patient, surgery is the preferred choice of treatment to alleviate the persisting symptoms. This is one condition where on table intra op diagnosis supersedes the imaging and histological diagnosis. Here, we discuss the case report of 32 year old male, known diabetic for 4 years, who presented with complaints of abdominal pain, intermittent for over 5 years, with no evidence of intestinal obstruction. Imaging showed abdominal cocoon of small bowel loops and mid gut rotation anomaly with internal hernia. Laparoscopically the cocoon sac was removed and adhesiolysis was done. This case report is to add richness to limited amount literary resources available about abdominal cocoon syndrome.

Research advances on diagnosis and treatment of abdominal cocoon / 中华消化外科杂志

Abdominal cocoon is a rare,peritoneal disease with a disorder of the autoimmune system.It is a disease of acute and chronic intestinal obstruction caused by a thickened peritoneum that wraps or partially wraps the small intestine.The cause and mechanism of its etiology are not yet fully understood which need further study.The clinical features of the abdominal cocoon symptoms are lack of specificity,which can easily lead to misdiagnosis and missed diagnosis.There is no perfect treatment standard for treatment.With the promotion and popularization of CT,Iaparoscopic and other technologies,the diagnosis and treatment of abdominal cocoon symptoms can be improved.Although conservative treatment can delay the progression of abdominal cocoon symptoms,it still cannot solve the problem fundamentally.Surgical treatment is still the best choice for patients with abdominal cocoon.

Abdominal cocoon: A roport of 5 cases / 中华普通外科杂志

Objective To explore the clinical characteristics and treatment of abdominal cocoon.Methods Clinical data of 5 cases with abdominal cocoon in our hospital from October 2015 to February 2017 were analyzed.Results 5 patients with abdominal cocoon were recruited,including 3 males and 2 females.Of the 5 patients,one with gastric cancer,1 with colon cancer,2 with rectal cancer and 1 with cryptorchidism.All the patients have no symptoms of intestinal obstruction.Laparotomy revealed that all or part of small intestine had been wrapped in a layer of tough fibrous membrane.Excision of primary lesion without lysis of adhesions were done.No symptoms of intestinal obstruction and intestinal fistula occurred after operation.Conclusions The preoperative diagnosis of abdominal cocoon is difficult.It is often inadvertently found in the operation,asymptomatic patients,do not need treatment.

Idiopathic Sclerosing Encapsulating Peritonitis Revealed by Intestinal Obstruction.

Sclerosing encapsulating peritonitis (SEP) is a very rare entity characterized by encasement of small intestine by a fi­brocollagenous membrane. It is divided into primary (idiopathic) which is named as abdominal cocoon and secondary forms. The preoperative diagnosis is difficult and most cases are diagnosed intraoperatively. A conservative treatment approach is the most suitable management strategy in asymptomatic idiopathic SEP. In this paper, we aimed to present a case of idiopathic SEP revealed by intestinal obstruction.

Computed tomography features of small intestinal obstruction caused by primary abdominal cocoon / 中华消化外科杂志

Objective To summarize the computed tomography (CT) features of small intestinal obstruction caused by primary abdominal cocoon and investigate the essentials of diagnosis and differential diagnosis.Methods The retrospective descriptive study was adopted.The clinical data of 1 patient with small intestinal obstruction caused by primary abdominal cocoon who was admitted to the Second Affiliated Hospital of Jiaxing University on October 6,2014 were collected.The patient underwent abdominal CT on admission and at 10 hours after admission.The patient received emergency exploratory laparotomy after preoperative preparation,and then postoperative regular symptomatic treatment and pathological examination.Results of abdominal CT were observed,including imaging features of abdominal masses,extent of small intestinal obstruction,situation of intestinal tube within the masses,vessel distribution in the mesentery and fibrous capsules around the mesentery.Situation of operation,routine blood test,biochemical indicator,blood coagulation indexes,postoperative recovery,complications,results of pathological examination and situation of patient during follow-up were recorded.The follow-up by telephone interview and outpatient examination was applied to the patient till October 31,2015,including detecting the dietary,with or without symptoms of abdominal pain and distension,haematemesis and hematochezia,routine blood retest,liver function,renal function and CT.Results Results of abdominal CT on admission:(1) coronal plain scan of abdominal CT showed that there were signs of incomplete intestinal obstruction,and local small intestinal dilatation and gas accumulation in left abdominal region without specific sign.(2) Plain scan of abdominal CT showed that there were the coated sign with thickened fibrous capsules around the intestinal tube, banana shape ' with agglomerate and expanding-distortion intestinal tube and aggregative,stretching and twisting mesentery with abnormal vessel distribution.(3) Sagittal reconstruction images of abdominal CT showed that a huge mass consisted of fibrous capsules as cocoon and agglomerate and expanding-distortion intestinal tube was petal-like and fixed on posterior abdominal wall.(4) Coronal reconstruction images of abdominal CT showed that agglomerate and expanding-distortion intestinal tube was annularly surrounded by uneven thickness fibrous capsules with abnormal vessel distribution in the mesentery.Results of abdominal CT at 10 hours after admission:(1) coronal plain scan of abdominal CT showed that small intestinal obstruction was obviously exacerbated and expanding intestinal tubes were increased and aggravated.(2) Plain scan of abdominal CT showed that a typical sign of small intestinal obstruction was exacerbated and there were multiple air-fluid levels in the agglomerate and expanding-distortion intestinal tube with fluid and gas accumulation.Patient underwent successful enterodialysis + resection of fibrous capsules.During operation,a huge mass in the intestine from suspensory ligament of duodenum to ileocecum was fixed on posterior abdominal wall and surrounded by dense,smooth and white fibrous capsules,partial colon was also surrounded by fibrous capsules and greater omentum was missing.Patient received the postoperative supporting treatments of fasting,anti-infection and inhibition of acid.Number of white blood cells,absolute value and percentage of neutrophils,levels of high-sensitivity C-reactive protein and procalcitonin were 17.10 × 109/L,15.70 × 109/L,91.5％,127.49 mg/L and 1.370 μg/L by blood routine retest at postoperative day 1,respectively.Patient had normal liver,renal and coagulation functions.Fluid diet intake at postoperative week 1 was gradually replaced by normal diet intake.Patient had normal liver and renal functions by blood routine retest at postoperative day 10 and a good recovery without intestinal fistula,abdominal and pulmonary infections and other complications.Postoperative pathological examination showed that gross specimen was mainly composed of cocoon-shaped,grayish white and tough fibrous capsules.Fibrous capsules were consisted of proliferative fibrofatty tissues by microscope observation,with small vascular hyperplasia and large numbers of the inflammatory cell infiltration.Patient was diagnosed with small intestinal obstruction caused by primary abdominal cocoon after operation,and followed up for 1 year with normal diet intake and without abdominal pain and distension,nausea and vomiting,melena and discomfort.There was normal blood routine retest,liver and renal functions and distribution of the intestine in abdomen by CT examination.No dilatation of the intestinal tube was found and strip-like high density shadow in ileocecum was detected and considered as remnant fibrous capsules.Conclusion Imaging features of small intestinal obstruction caused by primary abdominal cocoon include agglomerate and expanding-distortion intestinal tube fixed on abdomen,partial intestinal tubes dilatation,intestinal fluid accumulation and air-fluid level,aggregative,stretching and twisting mesentery with abnormal vessel distribution,thickened fibrous capsules around intestinal loops and among intestinal tubes.

Evaluation of multi-slice spiral CT in diagnosis of abdominal cocoon / 实用放射学杂志

Objective To investigate the value of multi-slice CT in diagnosis of abdominal cocoon.Methods CT findings of six cases with pathologically proved abdominal cocoon were collected and analyzed retrospectively.The three-dimensional imagines were obtained including multi-planar reconstruction(MPR),maximum intensity projection(MIP)and volume rendering(VR)at workstation,the rela-tionships between the lesions and surrounding structure were observed.Results A group of local small intestine were seen gathered in all six cases,the coiled intestine arranged inaccordionshape orbananashape.The fibrous capsule were seen around them with different thickness,which were low density and slightly enhancement.Mesenteric arteries showed abnormal changes,showing ten-sion,aggregation.Conclusion MSCT can provide a wealth of diagnostic information and is the best method of examination abdomi-nal cocoon.

A Pre-Operatively Diagnosed Abdominal Cocoon.

Abdominal Cocoon or idiopathic encapsulating peritonitis is a rare cause of intestinal obstruction. It more commonly occurs in young adolescent girls and the diagnosis is usually made at laparotomy. Recent case reports suggest that it is not uncommon in males and pre-operative diagnosis is possible by radiological investigations. We present a case of abdominal cocoon in an adult male, pre-operatively diagnosed by ultrasound and computerized tomography.

Abdominal cocoon: Case report of a rare cause of intestinal obstruction.

Abdominal cocoon or sclerosing encapsulated peritonitis is a rare cause of intestinal obstruction often seen in adolescent girls. We present a case of an abdominal cocoon in a 14-year-old female presenting as a surgical emergency. The patient underwent excision of the involved segment of small bowel along with a part of ascending colon. Gross morphology revealed intestinal coils wrapped within a thick fibrous membrane. Diagnosis of this condition is seldom possible on radiological imaging. Characteristic gross appearance is showcased in our case, to create more awareness of this finding.

Left Paramesocolic Hernia Presenting as Post Appendicectomy Abdominal Cocoon.

We describe a rare case of left mesocolic hernia presenting as post appendicectomy intestinal obstruction in a girl. Laparotomy confirmed partial peritoneal encapsulation of upper small bowel due to herniation of jejunal loops into the left mesocolic hernia sac. Reduction of contents, resection of the sac and repair of the defect concluded the procedure uneventfully.

Imaging diagnosis of primary abdominal cocoon / 中国综合临床

Objective To investigate the imaging characteristics of primary abdominal cocoon in order to improve diagnosis level.Methods The imaging data of 5 cases of primary abdominal cocoon proved by surgery and pathology were retrospectively analyzed.Results Abdominal plain X-ray suggested intestinal obstruction in 3 out of 5 cases.The gastrointestinal barium meal showed cauliflower signal in all 5 cases;CT suggested a conglomeration of multiple small bowel loops in the 5 cases and the intestinal loops seemed to be encapsulated in a thickened capsule.Conclusion Abdominal cocoon should be taken into consideration when gastrointestinal barium meal shows cauli flower signal and CT displays conglomeration.

Sclerosing Encapsulating Peritonitis (Abdominal Cocoon) after Abdominal Hysterectomy

Sclerosing encapsulating peritonitis (SEP) is a poorly understood and rarely documented cause of small bowel obstruction. Although recurrent peritonitis has been reported as the main contributory factor leading to secondary SEP, the pathogenesis of primary (idiopathic) SEP is still uncertain. A 40-year-old woman with a history of total abdominal hysterectomy due to gestational trophoblastic disease presented with progressive lower abdominal pain and abdominal distension. Ultrasonography and contrast-enhanced abdomen-pelvis computed tomography of the abdomen revealed encapsulation of the entire small bowel with a sclerotic capsule. At laparotomy, a fibrous thick capsule encasing small bowel loops was revealed. Extensive adhesiolysis and removal of the capsule from the bowel loops were performed. The patient recovered uneventfully; she was discharged without complications. SEP is a rare cause of small bowel obstruction. We treated a case of abdominal cocoon with intestinal partial obstruction in a woman with a history of abdominal hysterectomy due to gestational trophoblastic disease. Surgical treatment was effective and the patient recovered without complication.

Diagnosis and treatment of abdominal cocoon:a report of 16 patients / 中国普通外科杂志

Objective To explore the diagnosis and treatment of abdominal cocoon. Methods The clinical data of 16 patients with abdominal cocoon were analyzed retrospectively . Result All the 16 patients with abdominal cocoon were treated and confirmed by operation. Before operation, 11 patients were misdiagnosed as mechanical intestinal obstruction, 4 as chronic appendicitis, and 1 as abdominal tumor.All patients were operated on and postoperative complications were found in 2 patients. All patients were curred clinically and followed up for 1-10years. 2 patients were died of relapsing intestinal obstruction 1,5 years after operation. 2 occurred relapsing incomplete intestinal obstruction accompaning with malnutrition, 12 patients were good during the follow up period. Conclusions Preoperative diagnosis of abdominal cocoon is difficult. The diagnosis mainly depends on the upper gastrointestinal radiography, B-ultrasonography and CT. Removal of the membrane and releasing the intestine adhesions is an effective method in treating this disease.

Surgical treatment for abdominal cocoon / 中国微创外科杂志

Objective To explore the diagnosis and treatment of abdominal cocoon. Methods This article retrospectively summarized clinical data of 6 cases of abdominal cocoon. Results All the 6 cases of abdominal cocoon were misdiagnosed preoperatively: 5 cases were diagnosed as having intestinal obstruction and 1 case,abdominal mass.Partial or total capsule resection was adopted in all the 6 cases,1 of which simultaneously underwent intestinal arrangement. Conclusions Abdominal cocoon is not specific,which is difficult to diagnose preoperatively.Upper digestive tract radiography,B-ultrasonography and CT scanning help to make the diagnosis.Partial or total capsule resection,intestinal arrangement,intestinal resection and release for intestinal adhesion are usually adopted as the treatment.

A case of abdominal cocoon

Abdominal cocoon is a rare disease of the peritoneum and almost invariably presents as an acute or subacute intestinal obstruction with or without a mass. The etiology of this disease is largely unknown and abdominal cocoon of unknown etiology has been limited to the tropical and subtropical zones and primarily affects young adolescent females. In the temperate zone, only one case has been reported from the United Kingdom, but the patient was also born in Pakistan. No case of abdominal cocoon purely developed in the temperate zone has been reported. Recently, we experienced a case of abdominal cocoon in a 34-year-old female patient(Korean) who had never been abroad. The diagnosis was made postoperatively by reviewing the literature. We herein report this rare condition developed in an unusual geographical location with a brief review of the literature.