Idiopathic sclerosing encapsulating peritonitis: Abdominal cocoon

Jenny N Tannoury, Bassam N Abboud, Department of General Surgery, Faculty of Medicine, Hotel Dieu de France Hospital, Saint-Joseph University, Beirut 16-6830, Lebanon.
World Journal of Gastroenterology (Impact Factor: 2.37). 05/2012; 18(17):1999-2004. DOI: 10.3748/wjg.v18.i17.1999
Source: PubMed


Abdominal cocoon, the idiopathic form of sclerosing encapsulating peritonitis, is a rare condition of unknown etiology that results in an intestinal obstruction due to total or partial encapsulation of the small bowel by a fibrocollagenous membrane. Preoperative diagnosis requires a high index of clinical suspicion. The early clinical features are nonspecific, are often not recognized and it is difficult to make a definite pre-operative diagnosis. Clinical suspicion may be generated by the recurrent episodes of small intestinal obstruction combined with relevant imaging findings and lack of other plausible etiologies. The radiological diagnosis of abdominal cocoon may now be confidently made on computed tomography scan. Surgery is important in the management of this disease. Careful dissection and excision of the thick sac with the release of the small intestine leads to complete recovery in the vast majority of cases.

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    • "Presently there is no consensus on the classification of these 3 distinct pathological entities that effectively constitute small bowel encapsulation [1]. Whereas PE is an embryological disorder and abdominal cocoon is an idiopathic condition, SEP is today increasingly associated with peritoneal dialysis as well as a variety of other conditions [2] "
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    ABSTRACT: Small bowel encapsulation is a rare entity which is usually found incidentally at autopsy. We report the first case of peritoneal encapsulation encountered serendipitously at laparotomy undertaken for penetrating abdominal trauma and review the literature on peritoneal encapsulation. We also compare this phenomenon to abdominal cocoon and sclerosing encapsulating peritonitis.
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    ABSTRACT: Sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction that is usually diagnosed during a laparotomy; however, a preoperative diagnosis is possible. Sclerosing encapsulating peritonitis can be classified as primary or idiopathic and secondary types and only about 70 cases of idiopathic type have been reported since it was first described. It is characterized by a total or partial encasement of the small bowel by a thick fibrotic membrane. This report presents a series of three cases in which a diagnosis of idiopathic SEP was made preoperatively based on the clinical features and radiological findings, which were confirmed by a laparotomy and histopathology. All of the cases were successfully managed by the excision of the membrane. This report demonstrates that based on the clinical features and radiological investigations, in the absence of other plausible etiologies for intestinal obstruction, it is possible to suspect a preoperative diagnosis of SEP, thereby preventing a "surprise" finding during a laparotomy and allowing for better management.
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    ABSTRACT: BACKGROUND: Idiopathic sclerosing encapsulating Peritonitis (SEP) has been increasingly recognized as an obscure cause of bowel obstruction. It contrasts the traditional abdominal cocoon condition that afflicts patients on peritoneal dialysis, in that no cause has been elucidated. METHODS (CASE REPORT): We present a case of a 24-year-old south Asian with signs and symptoms of small bowel obstruction. He had similar attacks in the past. Radiographic work up suggested idiopathic SEP. Upon laparotomy, the condition was confirmed and the procedure was completed successfully. No recurrence of the symptoms was detected on follow-up. RESULTS AND CONCLUSIONS: Although rare, SEP management is straightforward once the condition is recognized preoperatively or intraoperatively. A comprehensive review of the literature is presented. GRUNDLAGEN: Die idiopathische sklerosierende Peritonitis (ISP) stellt eine seltene Ursache für Darmobstruktionen dar und ist oft schwer nachzuweisen. METHODIK (FALLBERICHT): Wir berichten über einen 24-jährigen Patienten aus Asien mit den Zeichen eines Dünndarmileus und radiologischem Hinweis für ISP. Durch Laparotomie wurde der Verdacht bestätigt. Die Nachsorge war unauffällig. ERGEBNISSE UND SCHLUSSFOLGERUNGEN: ISP ist selten, bei Diagnose ist ein rasches Handeln angezeigt. Eine Literaturübersicht bestätigt diese Empfehlung. KeywordsSclerosing encapsulated peritonitis-Abdominal cocoon-Bowel obstruction SchlüsselwörterSklerosierende Peritonitis-Ileus-Darmobstruktion
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