Idiopathic Sclerosing Encapsulating Peritonitis in a Patient with Atypical Symptoms and Imaging Findings

Sclerosing encapsulating peritonitis is a rare condition caused by a fibrotic membrane covering the small bowel which may lead to abdominal pain or obstruction. The cause may be primary and idiopathic or secondary to several diseases, treatments, and/or medications. The condition typically presents with bowel obstruction, and only one previous case has described ascites as the presenting sign. Sclerosing encapsulating peritonitis is typically diagnosed intraoperatively. We present a case of a patient who presented with atypical clinical symptoms including respiratory distress, recurrent abdominal ascites, and failure to thrive who was diagnosed nonoperatively.

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Difficult to Diagnose the Cause of Intestinal Obstruction due to Abdominal Cocoon Syndrome

European Journal of Case Reports in Internal Medicine ◽

10.12890/2021_002588 ◽

2021 ◽

Author(s):

Cemal Ulusoy ◽

Andrej Nikolovski ◽

Nazım Öztürk

Keyword(s):

Small Bowel ◽

Intestinal Obstruction ◽

Small Bowel Obstruction ◽

Abdominal Mass ◽

Clinical Signs ◽

Rare Condition ◽

Abdominal Cocoon ◽

Sclerosing Encapsulating Peritonitis ◽

Encapsulating Peritonitis ◽

Palpable Abdominal Mass

Abdominal cocoon syndrome (sclerosing encapsulating peritonitis) is a rare condition associated with clinical signs of intestinal dysfunction, episodes of small bowel obstruction and sometimes a palpable abdominal mass. We present the case of a 46-year-old male patient with clinical signs of intestinal obstruction caused by primary sclerosing encapsulating peritonitis.

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Sclerosing Encapsulating Peritonitis

Bangladesh Critical Care Journal ◽

10.3329/bccj.v2i1.19969 ◽

2014 ◽

Vol 2 (1) ◽

pp. 42-43

Author(s):

Sharmistha Roy ◽

Tapash Kumar Maitra ◽

Samiron Kumar Mondal

Keyword(s):

Small Bowel ◽

Rare Condition ◽

Young Girl ◽

Abdominal Cocoon ◽

Operative Finding ◽

Sclerosing Encapsulating Peritonitis ◽

Encapsulating Peritonitis

Sclerosing Encapsulating Peritonotis ( SEP) or Abdominal Cocoon is a rare condition characterized by total or partial encasement of the small bowel by a fibrocollagenous cocoon like sac. It was first described and named by Foo et al in 1978. Here we present a case of SEP or cocoon in a young girl with typical radiological and per operative finding. DOI: http://dx.doi.org/10.3329/bccj.v2i1.19969 Bangladesh Crit Care J March 2014; 2 (1): 42-43

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Abdominal Cocoon: A Potential Pitfall in Patients with Ovarian Carcinoma

Tumori Journal ◽

10.1177/030089161209800633 ◽

2012 ◽

Vol 98 (6) ◽

pp. e176-e178 ◽

Cited By ~ 2

Author(s):

Rut Isacson ◽

Amiel Segal ◽

Joseph Alberton ◽

Constantin Reinus ◽

Alon Schwarz ◽

...

Keyword(s):

Ovarian Cancer ◽

Small Bowel ◽

Intestinal Obstruction ◽

Cancer Patients ◽

Rare Condition ◽

Unusual Complication ◽

Abdominal Cocoon ◽

Case Presentation ◽

Sclerosing Encapsulating Peritonitis ◽

Encapsulating Peritonitis

Background Abdominal cocoon, or sclerosing encapsulating peritonitis, is a rare condition characterized by partial or total encasement of small bowel and mesentery by a thick fibrocollagenous sack that looks like a cocoon. Within the sack, bowel loops are drawn together causing intestinal obstruction. Case presentation We report on a 57-year-old female patient who developed a very unusual complication of ovarian cancer: abdominal cocoon formation. Conclusions This report highlights the need for a timely diagnosis of sclerosing encapsulating peritonitis in cancer patients.

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An intraoperative diagnosis of sclerosing encapsulating peritonitis: a case report

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa329 ◽

2020 ◽

Vol 2020 (9) ◽

Author(s):

Jonathan Sivakumar ◽

Gregor Brown ◽

Laurence Galea ◽

Julian Choi

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Case Reports ◽

Fibrous Tissue ◽

Rare Condition ◽

Exploratory Laparotomy ◽

Intraoperative Diagnosis ◽

Sclerosing Encapsulating Peritonitis ◽

Encapsulating Peritonitis

Abstract Primary sclerosing encapsulating peritonitis (SEP) is an idiopathic and rare condition characterized by chronic peritoneal inflammation. We describe the case of an intraoperative diagnosis of SEP, presenting as a mimicker of small bowel obstruction. The patient was a 59-year-old male with suspected small bowel obstruction. On exploratory laparotomy, it was noted that there was thick fibrous tissue involving the visceral and parietal peritoneum enveloping grossly dilated loops of small bowel. This case reports on the histopathological features of peritoneal biopsies as well as radiological findings. There is no consensus regarding the standard management for idiopathic SEP. The present case demonstrates a significant improvement in the patient’s condition with conservative management alone. A critical teaching point is that in the absence of an obvious cause, SEP is a rare but important differential diagnosis for surgeons to consider in the context of recurrent bowel obstruction.

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Analysis of the risk of ovarian torsion in 49 consecutive pediatric patients treated at a single institution

World Journal of Pediatric Surgery ◽

10.1136/wjps-2018-000009 ◽

2019 ◽

Vol 2 (2) ◽

pp. e000009

Author(s):

Koshiro Sugita ◽

Takafumi Kawano ◽

Mukai Motoi ◽

Toshihiro Muraji ◽

Shun Onishi ◽

...

Keyword(s):

Abdominal Pain ◽

Pediatric Patients ◽

Clinical Symptoms ◽

White Cell Count ◽

Ovarian Torsion ◽

Imaging Findings ◽

Single Institution ◽

Exact Test ◽

Cystic Masses ◽

Ovarian Masses

PurposeAn early diagnosis of ovarian torsion is sometimes difficult due to variable clinical symptoms and non-specific imaging findings. We retrospectively reviewed patients with pediatric ovarian masses manifesting torsion.MethodsFifty-eight ovarian masses (55 episodes) in 49 non-neonatal patients treated from April 1984 to March 2017 were retrospectively analyzed. The Mann-Whitney U test and Fisher’s exact test were used for the statistical analysis.ResultsThe median age of these 55 episodes was 10.5 years old (range 1.0–23.0). Thirty-three patients presented with abdominal pain. Forty-five tumors and 13 cystic masses were resected and diagnosed pathologically (50 benign and 8 malignant). Torsion was identified in 15 cases (25.9%) at operation. The torsion masses were all benign, and 8 ovaries (53.3%) were successfully preserved. Comparing the torsion cases with the non-torsion cases, only the white cell count was significantly higher in the torsion cases (p=0.0133) and in the patients presented with abdominal pain (p=0.0068). The duration of abdominal pain was significantly shorter in ovary preserved cases than in oophorectomy cases.ConclusionThe white blood cell may be a helpful indicator of the presence of torsion as well as the need for surgery.

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Abdominal Pain and Vomiting in a Patient with Over-anticoagulation -- a Rare Case of Spontaneous Intramural Hematoma of the Jejunum

10.22514/sv.2020.16.0035 ◽

2020 ◽

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Small Bowel ◽

Vitamin K Antagonists ◽

Intramural Hematoma ◽

Rare Condition ◽

The Body ◽

Diagnostic Process ◽

Tomography Scan

Anticoagulants, including vitamin K antagonists, are widely used for therapeutic and prophylactic purposes. Bleeding is the most important complication of anticoagulant therapy due to over-anticoagulation. Over-anticoagulation may present in unusual ways, such as spontaneous intramural hematoma of the small bowel. The classical clinical picture consists of abdominal pain, small bowel obstruction (that can present as vomiting) and hemorrhagic symptoms that can be related to the bowel or other parts of the body. Radiological examinations are essential for the diagnosis. Ultrasound can be helpful in the diagnostic process, but computed tomography is the procedure of choice. Conservative treatment is usually successful, including procedures that stop the over-anticoagulant consequences. A surgical approach is reserved for complications such as necrosis or perforation of the bowel. The diagnosis is definitively confirmed by the spontaneous resolution of the pathological findings on a follow-up computed tomography scan. We present a case of a 72-year-old woman who was diagnosed with this rare condition affecting the jejunum in the emergency department in our hospital.

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