An unusual case in surgical emergency: Abdominal cocoon and its laparoscopic management

Ertem, Metin; Ozben, Volkan; Gök, Hakan; Aksu, Ersin

doi:10.4103/0972-9941.83511

Cited by 21 publications

(12 citation statements)

References 4 publications

(9 reference statements)

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“…[3,9,21] There are a limited number of publications suggesting that mycophenolate mofetil may be useful in patients with frequent recurrent symptoms after surgery of membrane excision and adhesiolysis by laparoscopic approach in ACS. [16,22,23] Adhesiolysis and partial or full capsule excision were performed in all cases. In one patient, partial small bowel resection and end jejunostomy were performed due to the necrosis that arises from a vascular failure in the small intestine.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Cocoon Syndrome: A rare Cause of Acute Abdomen Syndrome

Çolak¹

2019

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: A rare cause of acute abdomen or intestinal obstruction, the abdominal cocoon syndrome is also described in the literature as sclerosing peritonitis or sclerosing encapsulating peritonitis. Abdominal cocoon is characterized by the total or partial wrapping of the abdominal organs by a fibrous membrane. Although it is usually observed in young women, the etiology is unknown. The diagnosis is usually made during laparotomy. In this case series, we aimed to present seven patients diagnosed with abdominal cocoon syndrome during operation. METHODS: The records of patients who underwent laparotomy for abdominal pain and/or intestinal obstruction in our hospital and diagnosed as abdominal cocoon during operation between January 2012 and November 2018 were retrospectively reviewed. The demographic characteristics of the patients, etiologic factors, surgical procedures, operative findings and follow-up of the patients were recorded. RESULTS: Four out of seven patients who were operated for abdominal cocoon were male and 3 of them were female. The median age of patients was 61 (57-63) years in male and 39.6 (28-49) years in female. Six of the patients were operated in emergency conditions with the diagnosis of an acute abdomen or ileus. One of the patients was operated with the diagnosis of an intra-abdominal mass in elective conditions. In five out of seven patients, all of the small intestines were wrapped with a fibrous collagen capsule, while two of the patient intestines were partially wrapped with a fibrous collagen capsule. Four of the patients had no underlying disease, while one of the patients had Familial Mediterranean Fever (FMF), one had Endometriosis and one had beta-blocker medication. One patient who had small bowel necrosis and septic peritonitis were observed during the operation and died post operative 6 th days. Postoperative complications were not observed in the follow-up of other patients and reoperation was not required due to recurrence. CONCLUSION: Abdominal cocoon is a condition that is usually diagnosed during operation in patients that were operated for reasons, such as the acute abdomen or intestinal obstruction. When the diagnose delayed, death can be seen due to small bowel necrosis and septic complications. High clinical suspicion and radiological imaging are important in the preoperative diagnosis. Treatment is required adhesiolysis and excision of the fibrous membranes.

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Section: Discussionmentioning

confidence: 99%

Abdominal Cocoon Syndrome: A rare Cause of Acute Abdomen Syndrome

Çolak¹

2019

Ulus Travma Acil Cerrahi Derg

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“…There is limited evidence in the literature for a successful laparoscopic membrane excision and adhesiolysis. The advantage of laparoscopy is that it can be added as a tool that aids in diagnosis of the condition [10]. The use of antiadhesion measures intraoperatively has no clear evidence whether or not it may prevent the recurrence of the condition.…”

Section: Discussionmentioning

confidence: 99%

Intestinal Obstruction in a Patient with Sclerosing Encapsulating Peritonitis

Obaid

Alhalabi

Ghonami

2017

Case Reports in Surgery

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Sclerosing encapsulating peritonitis (SEP) is a rare disorder that is characterized by encapsulation of bowel loops by thick fibrinogenous case. Most patients present with vague abdominal symptoms. It is challenging to diagnose the condition preoperatively. Surgical management is preserved for patients with small bowel obstruction with no improvement on conservative measures or for those with signs of bowel ischemia (Li et al., 2014; Habib et al. 2011). Herein, we discuss the clinical signs and symptoms, the radiological features, the surgical management, and outcome of SEP based on a patient who underwent surgery in our hospital.

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“… 1 With few cases described in literatures. 1,2,7 Cocoon abdomen is mostly observed in young girls living in tropical and subtropical countries of the world, especially China, Malaysia, Singapore, Pakistan, India, Nigeria, Kenya, Saudi Arabia, Israel, and South Africa. 1,3 Although few cases have been documented in males.…”

Section: Discussionmentioning

confidence: 99%

“… 1,3 It can be classified as primary (idiopathic) or secondary. 4,5 The correct diagnosis is not often made preoperatively, 6,7 as CT and MRI finding are nonspecific. 8 …”

Section: Introductionmentioning

confidence: 99%

Idiopathic sclerosing encapsulating peritonitis (abdominal cocoon) in adult male. A case report

Ani

Zayani

Najmeddine

et al. 2014

International Journal of Surgery Case Reports

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INTRODUCTIONAbdominal cocoon (sclerosing encapsulating peritonitis) (SEP) is a rare condition, mostly affecting adolescent girls living in tropical/subtropical region. Its etiology is unknown. It may cause acute or sub-acute intestinal obstruction.PRESENTATION OF CASEWe report here a 39 year old male who complained of long standing colicky abdominal pain, with significant weight loss. Abdomen CT scan showed clumping of ileal loops at the level of umbilicus, with a thin capsule surrounding it. Laparoscopy revealed abdominal cocoon, biopsy of which showed dense hypocellular fibro-collagenous tissue with no neoplastic or granulomatous process. Excision of fibrous tissue and release of adhesions was done. Patient was symptoms free after five months follow up.DISCUSSIONAbdominal exploration is usually needed for the diagnosis and treatment of abdominal cocoon. A thick fibrotic peritoneal wrapping of the bowel is usually found. Complete recovery is the result in majority of cases after surgical removal of the wrap causing the cocoon.CONCLUSIONPrimary sclerosing encapsulating peritonitis (cocoon abdomen) diagnosis needs a high index of suspicion, as signs and symptoms are nonspecific and imaging findings are not always conclusive. Careful excision of the accessory peritoneal sac and lysis of adhesions between bowels is the best treatment. Prognosis is generally good.

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An unusual case in surgical emergency: Abdominal cocoon and its laparoscopic management

Cited by 21 publications

References 4 publications

Abdominal Cocoon Syndrome: A rare Cause of Acute Abdomen Syndrome

Abdominal Cocoon Syndrome: A rare Cause of Acute Abdomen Syndrome

Intestinal Obstruction in a Patient with Sclerosing Encapsulating Peritonitis

Idiopathic sclerosing encapsulating peritonitis (abdominal cocoon) in adult male. A case report

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