BACKGROUND Abdominal cocoon syndrome(ACS)represents a category within sclerosing encapsulating peritonitis,characterized by the encapsulation of internal organs with a fibrous,cocoon-like membrane of unknown origin,re...BACKGROUND Abdominal cocoon syndrome(ACS)represents a category within sclerosing encapsulating peritonitis,characterized by the encapsulation of internal organs with a fibrous,cocoon-like membrane of unknown origin,resulting in bowel obstruction and ischemia.Diagnosing this condition before surgery poses a cha-llenge,often requiring confirmation during laparotomy.In this context,we depict three instances of ACS:One linked to intestinal obstruction,the second exclu-sively manifesting as intestinal ischemia without any obstruction,and the final case involving a discrepancy between the radiologist and the surgeon.CASE SUMMARY Three male patients,aged 53,58,and 61 originating from Northern Thailand,arrived at our medical facility complaining of abdominal pain without any prior surgeries.Their vital signs remained stable during the assessment.The diagnosis of abdominal cocoon was confirmed through abdominal computed tomography(CT)before surgery.In the first case,the CT scan revealed capsules around the small bowel loops,showing no enhancement,along with mesenteric congestion affecting both small and large bowel loops,without a clear obstruction.The second case showed intestinal obstruction due to an encapsulated capsule on the CT scan.In the final case,a patient presented with recurring abdominal pain.Initially,the radiologist suspected enteritis as the cause after the CT scan.However,a detailed review led the surgeon to suspect encapsulating peritoneal sclerosis(ACS)and subsequently perform surgery.The surgical procedure involved complete removal of the encapsulating structure,resection of a portion of the small bowel,and end-to-end anastomosis.No complications occurred during surgery,and the patients had a smooth recovery after surgery,eventually discharged in good health.The histopathological examination of the fibrous membrane(cocoon)across all cases consistently revealed the presence of fibro-collagenous tissue,without any indications of malignancy.CONCLUSION Individuals diagnosed with abdominal cocoons commonly manifest vague symptoms of abdominal discomfort.An elevated degree of clinical suspicion,combined with the application of appropriate radiological evaluations,markedly improves the probability of identifying the abdominal cocoon before surgical intervention.In cases of complete bowel obstruction or ischemia,the established norm is the comprehensive removal of the peritoneal sac as part of standard care.Resection with intestinal anastomosis is advised solely when ischemia and gangrene have been confirmed.展开更多
Sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction that is characterized by a thick grayish-white fibrotic membrane encasing the small bowel. SEP can be classified as idiopathic,also ...Sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction that is characterized by a thick grayish-white fibrotic membrane encasing the small bowel. SEP can be classified as idiopathic,also known as abdominal cocoon,or secondary. It is difficult to make a definite pre-operative diagnosis. We experienced five cases of abdominal cocoon,and the case files were reviewed retrospectively for the clinical presentation,operative findings and outcome. All the patients presented with acute,subacute and chronic intestinal obstruction. Computed tomography (CT) showed characteristic findings of small bowel loops congregated to the center of the abdomen encased by a soft-tissue density mantle in four cases. Four cases had an uneventful post-operative period,one case received second adhesiolysis due to persistent ileus. The imaging techniques may facilitate pre-operative diagnosis. Surgery is important in the management of SEP.展开更多
We report a patient with HBV-related hepatocellular carcinoma （HCC） and refractory ascites who had received a peritoneal-venous shunt （PVS） 1 year before liver transplantation, Urgent surgical intervention followi...We report a patient with HBV-related hepatocellular carcinoma （HCC） and refractory ascites who had received a peritoneal-venous shunt （PVS） 1 year before liver transplantation, Urgent surgical intervention following bowel obstruction and failure of immunosuppression therapy. No intestinal obstruction was found during an initial PVS. However, intestinal obstruction developed 2 was found upon exploration. This is the first reported case of cocoon abdomen caused by PVS and exacerbated by liver transplantation.展开更多
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 b...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 f ibrocollagenous membrane.Preoperative diagnosis requires a high index of clinical suspicion.The early clinical features are nonspecif ic,are often not recognized and it is diff icult to make a def inite pre-operative diagnosis.Clinical suspicion may be generated by the recurrent episodes of small intestinal obstruction combined with relevant imaging f indings and lack of other plausible etiologies.The radiological diagnosis of abdominal cocoon may now be conf idently 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.展开更多
BACKGROUND Primary encapsulating peritoneal sclerosis(EPS)is a rare but devastating disease that causes fibrocollagenous cocoon-like encapsulation of the bowel,resulting in bowel obstruction.The pathogenesis,preventio...BACKGROUND Primary encapsulating peritoneal sclerosis(EPS)is a rare but devastating disease that causes fibrocollagenous cocoon-like encapsulation of the bowel,resulting in bowel obstruction.The pathogenesis,prevention,and treatment strategies of EPS remain unclear so far.Since most patients are diagnosed during exploratory laparotomy,for the non-surgically diagnosed patients with primary EPS,the surgical timing is also uncertain.CASE SUMMARY A 44-year-old female patient was referred to our center on September 6,2021,with complaints of abdominal distention and bilious vomiting for 2 d.Physical examination revealed that the vital signs were stable,and the abdomen was slightly distended.Computerized tomography scan showed a conglomerate of multiple intestinal loops encapsulated in a thick sac-like membrane,which was surrounded by abdominal ascites.The patient was diagnosed with idiopathic EPS.Recovery was observed after abdominal paracentesis,and the patient was discharged on September 13 after the resumption of a normal diet.This case raised a question:When should an exploratory laparotomy be performed on patients who are non-surgically diagnosed with EPS.As a result,we conducted a review of the literature on the clinical manifestations,intraoperative findings,surgical methods,and therapeutic effects of EPS.CONCLUSION Recurrent intestinal obstructions and abdominal mass combined with the imaging of encapsulated bowel are helpful in diagnosing idiopathic EPS.Small intestinal resection should be avoided.展开更多
Background: Encapsulating peritoneal sclerosis is a rare but life-threatening condition in peritoneal dialysis. It is associated with extensive thickening and fibrosis of the peritoneum resulting in recurrent small bo...Background: Encapsulating peritoneal sclerosis is a rare but life-threatening condition in peritoneal dialysis. It is associated with extensive thickening and fibrosis of the peritoneum resulting in recurrent small bowel obstructions and malnutrition. Herein we present case series of encapsulating peritoneal sclerosis diagnosed and treated in a large center of peritoneal dialysis in the State of Qatar followed by literature review to increase the awareness of physicians to it. Case Presentation: The data were collected retrospectively from 180 peritoneal dialysis patients at Hamad General Hospital, Doha, Qatar, between 2008 and 2016. The diagnosis of encapsulating peritoneal sclerosis was based on clinical and radiological features. Seven patients (3.8%) were diagnosed with encapsulating peritoneal sclerosis. The mean age of the patients was 49 years (range, 23 to 65 years). The mean duration of peritoneal dialysis was 6 years (range, 3 to 7 years). The mean peritonitis episodes were 1.8 (range 1 to 4 episodes). Five patients were diagnosed with encapsulating peritoneal sclerosis after stopping peritoneal dialysis, and two patients diagnosed while they were on peritoneal dialysis treatment. Five patients are still alive and were treated with oral prednisolone and tamoxifen. Two patients underwent adhesiolysis surgery, one of them died due to recurrent sepsis and malnutrition. Another patient died because of cardiac arrest during hemodialysis. The overall mortality rate was 28.5% in our series. Conclusions: Encapsulating peritoneal sclerosis is a rare and life-threatening peritoneal disease in chronic peritoneal dialysis patients. It requires high index of suspicion for early diagnosis and treatment.展开更多
Objective: To investigate the causes and preventive measures of pelvic floor peritoneal hernia after transabdominal perineal radical resection of rectal cancer. Patients and Methods: A 68-year-old patient with progres...Objective: To investigate the causes and preventive measures of pelvic floor peritoneal hernia after transabdominal perineal radical resection of rectal cancer. Patients and Methods: A 68-year-old patient with progressive exacerbation of Miles’ postoperative intestinal obstruction was retrospectively analyzed. Conservative treatment was ineffective, and surgery was performed again. Surgery confirmed that the obstruction was caused by a pelvic floor peritoneal hernia. The original reconstruction peritoneal suture needle spacing was too wide, resulting in peritoneal hiatus. Results: The early postoperative intestinal obstruction in this patient was not caused by inflammatory intestinal obstruction, stenosis of stoma, and intestinal adhesion, but by the formation of pelvic floor peritoneal hernia. Conclusion: Pelvic floor peritoneal hernia should not be ignored in the early stage of intestinal obstruction after Miles’ operation. Improper suture during pelvic floor peritoneal reconstruction is the main cause of pelvic floor peritoneal hernia.展开更多
文摘BACKGROUND Abdominal cocoon syndrome(ACS)represents a category within sclerosing encapsulating peritonitis,characterized by the encapsulation of internal organs with a fibrous,cocoon-like membrane of unknown origin,resulting in bowel obstruction and ischemia.Diagnosing this condition before surgery poses a cha-llenge,often requiring confirmation during laparotomy.In this context,we depict three instances of ACS:One linked to intestinal obstruction,the second exclu-sively manifesting as intestinal ischemia without any obstruction,and the final case involving a discrepancy between the radiologist and the surgeon.CASE SUMMARY Three male patients,aged 53,58,and 61 originating from Northern Thailand,arrived at our medical facility complaining of abdominal pain without any prior surgeries.Their vital signs remained stable during the assessment.The diagnosis of abdominal cocoon was confirmed through abdominal computed tomography(CT)before surgery.In the first case,the CT scan revealed capsules around the small bowel loops,showing no enhancement,along with mesenteric congestion affecting both small and large bowel loops,without a clear obstruction.The second case showed intestinal obstruction due to an encapsulated capsule on the CT scan.In the final case,a patient presented with recurring abdominal pain.Initially,the radiologist suspected enteritis as the cause after the CT scan.However,a detailed review led the surgeon to suspect encapsulating peritoneal sclerosis(ACS)and subsequently perform surgery.The surgical procedure involved complete removal of the encapsulating structure,resection of a portion of the small bowel,and end-to-end anastomosis.No complications occurred during surgery,and the patients had a smooth recovery after surgery,eventually discharged in good health.The histopathological examination of the fibrous membrane(cocoon)across all cases consistently revealed the presence of fibro-collagenous tissue,without any indications of malignancy.CONCLUSION Individuals diagnosed with abdominal cocoons commonly manifest vague symptoms of abdominal discomfort.An elevated degree of clinical suspicion,combined with the application of appropriate radiological evaluations,markedly improves the probability of identifying the abdominal cocoon before surgical intervention.In cases of complete bowel obstruction or ischemia,the established norm is the comprehensive removal of the peritoneal sac as part of standard care.Resection with intestinal anastomosis is advised solely when ischemia and gangrene have been confirmed.
文摘Sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction that is characterized by a thick grayish-white fibrotic membrane encasing the small bowel. SEP can be classified as idiopathic,also known as abdominal cocoon,or secondary. It is difficult to make a definite pre-operative diagnosis. We experienced five cases of abdominal cocoon,and the case files were reviewed retrospectively for the clinical presentation,operative findings and outcome. All the patients presented with acute,subacute and chronic intestinal obstruction. Computed tomography (CT) showed characteristic findings of small bowel loops congregated to the center of the abdomen encased by a soft-tissue density mantle in four cases. Four cases had an uneventful post-operative period,one case received second adhesiolysis due to persistent ileus. The imaging techniques may facilitate pre-operative diagnosis. Surgery is important in the management of SEP.
文摘We report a patient with HBV-related hepatocellular carcinoma （HCC） and refractory ascites who had received a peritoneal-venous shunt （PVS） 1 year before liver transplantation, Urgent surgical intervention following bowel obstruction and failure of immunosuppression therapy. No intestinal obstruction was found during an initial PVS. However, intestinal obstruction developed 2 was found upon exploration. This is the first reported case of cocoon abdomen caused by PVS and exacerbated by liver transplantation.
文摘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 f ibrocollagenous membrane.Preoperative diagnosis requires a high index of clinical suspicion.The early clinical features are nonspecif ic,are often not recognized and it is diff icult to make a def inite pre-operative diagnosis.Clinical suspicion may be generated by the recurrent episodes of small intestinal obstruction combined with relevant imaging f indings and lack of other plausible etiologies.The radiological diagnosis of abdominal cocoon may now be conf idently 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.
基金Supported by the Key Projects of Support Plan of Nanchang Science and Technology Bureau,Jiangxi Province,China,No.[2020]153
文摘BACKGROUND Primary encapsulating peritoneal sclerosis(EPS)is a rare but devastating disease that causes fibrocollagenous cocoon-like encapsulation of the bowel,resulting in bowel obstruction.The pathogenesis,prevention,and treatment strategies of EPS remain unclear so far.Since most patients are diagnosed during exploratory laparotomy,for the non-surgically diagnosed patients with primary EPS,the surgical timing is also uncertain.CASE SUMMARY A 44-year-old female patient was referred to our center on September 6,2021,with complaints of abdominal distention and bilious vomiting for 2 d.Physical examination revealed that the vital signs were stable,and the abdomen was slightly distended.Computerized tomography scan showed a conglomerate of multiple intestinal loops encapsulated in a thick sac-like membrane,which was surrounded by abdominal ascites.The patient was diagnosed with idiopathic EPS.Recovery was observed after abdominal paracentesis,and the patient was discharged on September 13 after the resumption of a normal diet.This case raised a question:When should an exploratory laparotomy be performed on patients who are non-surgically diagnosed with EPS.As a result,we conducted a review of the literature on the clinical manifestations,intraoperative findings,surgical methods,and therapeutic effects of EPS.CONCLUSION Recurrent intestinal obstructions and abdominal mass combined with the imaging of encapsulated bowel are helpful in diagnosing idiopathic EPS.Small intestinal resection should be avoided.
文摘Background: Encapsulating peritoneal sclerosis is a rare but life-threatening condition in peritoneal dialysis. It is associated with extensive thickening and fibrosis of the peritoneum resulting in recurrent small bowel obstructions and malnutrition. Herein we present case series of encapsulating peritoneal sclerosis diagnosed and treated in a large center of peritoneal dialysis in the State of Qatar followed by literature review to increase the awareness of physicians to it. Case Presentation: The data were collected retrospectively from 180 peritoneal dialysis patients at Hamad General Hospital, Doha, Qatar, between 2008 and 2016. The diagnosis of encapsulating peritoneal sclerosis was based on clinical and radiological features. Seven patients (3.8%) were diagnosed with encapsulating peritoneal sclerosis. The mean age of the patients was 49 years (range, 23 to 65 years). The mean duration of peritoneal dialysis was 6 years (range, 3 to 7 years). The mean peritonitis episodes were 1.8 (range 1 to 4 episodes). Five patients were diagnosed with encapsulating peritoneal sclerosis after stopping peritoneal dialysis, and two patients diagnosed while they were on peritoneal dialysis treatment. Five patients are still alive and were treated with oral prednisolone and tamoxifen. Two patients underwent adhesiolysis surgery, one of them died due to recurrent sepsis and malnutrition. Another patient died because of cardiac arrest during hemodialysis. The overall mortality rate was 28.5% in our series. Conclusions: Encapsulating peritoneal sclerosis is a rare and life-threatening peritoneal disease in chronic peritoneal dialysis patients. It requires high index of suspicion for early diagnosis and treatment.
文摘Objective: To investigate the causes and preventive measures of pelvic floor peritoneal hernia after transabdominal perineal radical resection of rectal cancer. Patients and Methods: A 68-year-old patient with progressive exacerbation of Miles’ postoperative intestinal obstruction was retrospectively analyzed. Conservative treatment was ineffective, and surgery was performed again. Surgery confirmed that the obstruction was caused by a pelvic floor peritoneal hernia. The original reconstruction peritoneal suture needle spacing was too wide, resulting in peritoneal hiatus. Results: The early postoperative intestinal obstruction in this patient was not caused by inflammatory intestinal obstruction, stenosis of stoma, and intestinal adhesion, but by the formation of pelvic floor peritoneal hernia. Conclusion: Pelvic floor peritoneal hernia should not be ignored in the early stage of intestinal obstruction after Miles’ operation. Improper suture during pelvic floor peritoneal reconstruction is the main cause of pelvic floor peritoneal hernia.
