Abdominal cocoon: a surgical challenge

Encapsulating peritoneal sclerosis (EPS) or sclerosing peritonitis best described as abdominal cocoon is a complex syndrome characterized by formation of a thick fibrocollagenous membrane that totally encloses the small intestinal loops. The etiology is varied and multifactorial. This complex disease is usually associated with continuous peritoneal dialysis (PD), tuberculosis, post renal transplant, or with long term use of beta blockers. A few cases may even be idiopathic in origin. The pathogenesis is attributed to conversion of epithelial cells from the peritoneal lining to mesenchymal cells leading to a formation of a thick membrane. The clinical features range from abdominal pain due to altered gut motility to frank features suggestive of intestinal obstruction. Making a pre-operative diagnosis is the biggest challenge in abdominal cocoon. However computerized tomography provides enough information to arrive at a diagnosis. Surgical intervention continues to remain the final option in an unremitting intestinal obstruction despite the role of conservative therapy using drugs proposed for treatment. The focus of management is early diagnosis and treatment in order to halt the progression to a frank cocoon. The paper reviews the etiopathogenesis and management of this intricate condition.

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The Role of Peritoneal Fibrosis in Encapsulating Peritoneal Sclerosis

Peritoneal Dialysis International ◽

10.1177/089686080502504s07 ◽

2005 ◽

Vol 25 (4_suppl) ◽

pp. 48-56 ◽

Cited By ~ 19

Author(s):

Masanobu Miyazaki ◽

Yukio Yuzawa

Keyword(s):

Peritoneal Dialysis ◽

Collagen Synthesis ◽

Potential Role ◽

Curative Treatment ◽

Peritoneal Fibrosis ◽

Dialysis Therapy ◽

Continuous Peritoneal Dialysis

Encapsulating peritoneal sclerosis (EPS) is a serious complication of long-term continuous peritoneal dialysis therapy. The progression of EPS has been classified into four stages by Kawanishi and colleagues: pre-EPS, and the inflammatory, encapsulating, and ileus stages. The key issue is how to diagnose EPS early enough to allow for curative treatment. In this article, we review the mechanisms of peritoneal fibrosis, especially from the perspective of collagen synthesis, and the potential role of that fibrosis in the pathogenesis of EPS.

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Experimental substantiation of using a synthetic peptide in the complex surgical treatment of acute intestinal obstruction

Nauchno-prakticheskii zhurnal «Patogenez» ◽

10.25557/2310-0435.2018.04.138-140 ◽

2018 ◽

pp. 138-140

Author(s):

А.А. Коваленко ◽

В.К. Хугаева

Keyword(s):

Surgical Treatment ◽

Intestinal Obstruction ◽

Intestinal Anastomosis ◽

Intestinal Wall ◽

Acute Intestinal Obstruction ◽

Study Objective ◽

Doppler Flowmetry ◽

Study Results ◽

Small Intestinal

Высокая смертность при хирургическом лечении острой кишечной непроходимости (ОКН) определила поиск новых методов сопутствующей терапии. Обнаруженная ранее высокая эффективность опиоидных пептидов в стимулировании лимфотока в микрососудах брыжейки тонкой кишки у крыс, восстановлении нарушенной микроциркуляцию и снижении смертности при ряде заболеваний, определила цель данного исследования: изучить роль фармакологической стимуляции лимфотока в динамике ОКН. В работе использовали методы: биомикроскопия, лазерная допплеровская флоуметрия брыжейки и стенки тонкой кишки крысы, регистрация сократительной активности лимфатических микрососудов ЛМ методом фотометрии, морфометрия микрососудов, видео- и фотосъемка. Полученные результаты предполагают наличие адаптационной роли у активатора микролимфоциркуляции (опиоидного пептида-171 прямого действия) в комплексном хирургическом лечении ОКН. Однократное орошение пептидом межкишечного анастомоза (после удаления) и поврежденного лигатурой фрагмента кишки (перед зашиванием операционной раны) увеличивало выживаемость животных с ОКН на 23%. У всех выживших животных отмечено восстановление: проходимости кишки, микроциркуляции в кровеносных и лимфатических микрососудах, а также структуры стенки кишки. High mortality in the surgical treatment of acute intestinal obstruction (AIO) has warranted the search for new methods of concomitant therapy. Opioid peptides have proved highly effective in stimulating the lymphatic flow in rat small intestinal mesenteric microvessels, restoring the impaired microcirculation, and reducing mortality in many diseases. This had determined this study objective: to investigate the role of lymphatic stimulation in the dynamics of AIO. The study used methods of biomicroscopy, laser Doppler flowmetry, and histological examination of the mesentery and the small intestinal wall in rats; recording the contractile activity of lymphatic microvessels using photometry; microvessel morphometry; video and photography. The study results suggested an adaptive role of the lymphatic microcirculation activator (direct-action opioid-171) in the complex surgical treatment of AIO. A one-time peptide irrigation of the intestinal anastomosis (after removal) and the intestinal injuried by the ligature (before the surgical wound was sutured) increased the survival of animals with AIO by 23%. In all surviving animals, recovery of the intestinal patency, blood and lymphatic microcirculation, and the intestinal wall structure was observed.

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Predictive factors for long-term mortality in miscellaneous cardiogenic shock: Protective role of beta-blockers at admission

Archives of Cardiovascular Diseases ◽

10.1016/j.acvd.2019.04.004 ◽

2019 ◽

Vol 112 (12) ◽

pp. 738-747 ◽

Cited By ~ 1

Author(s):

Clément Delmas ◽

Elisabeth Orloff ◽

Frédéric Bouisset ◽

Thomas Moine ◽

Barbara Citoni ◽

...

Keyword(s):

Cardiogenic Shock ◽

Predictive Factors ◽

Beta Blockers ◽

Protective Role ◽

Long Term Mortality

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Long-Term Survival in a Patient with Non-Small Cell Lung Cancer Presenting as Small Intestinal Obstruction

Onkologie ◽

10.1159/000292094 ◽

2010 ◽

Vol 33 (4) ◽

pp. 178-180 ◽

Cited By ~ 1

Author(s):

Tal Grenader ◽

Anthony Goldberg

Keyword(s):

Lung Cancer ◽

Intestinal Obstruction ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Small Cell ◽

Small Cell Lung ◽

Term Survival ◽

Small Intestinal Obstruction ◽

Small Intestinal

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Unusual small intestinal obstruction in adolescent girls: the abdominal cocoon

Journal of Pediatric Surgery ◽

10.1016/0022-3468(79)90071-x ◽

1979 ◽

Vol 14 (2) ◽

pp. 204-205

Author(s):

Lewis Spitz

Keyword(s):

Intestinal Obstruction ◽

Adolescent Girls ◽

Abdominal Cocoon ◽

Small Intestinal Obstruction ◽

Small Intestinal

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Abdominal Cocoon: An Unusual Cause of Intestinal Obstruction

Delta Medical College Journal ◽

10.3329/dmcj.v5i1.31437 ◽

2017 ◽

Vol 5 (1) ◽

pp. 49-52

Author(s):

Tapesh Kumar Paul ◽

Russel Ahmed Khan Lodi ◽

Shayda Ali ◽

Mohammad Arman Zahed Basunia ◽

Hasan Md Abdur Rouf

Keyword(s):

Small Intestine ◽

Intestinal Obstruction ◽

Rare Condition ◽

Complete Recovery ◽

Clinical Suspicion ◽

Unknown Etiology ◽

Imaging Findings ◽

Abdominal Cocoon ◽

Small Intestinal ◽

Encapsulating Peritonitis

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. 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. 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. Here a case of abdominal cocoon in a 45 years old male is presented due to its rarity and difficulty in preoperative diagnosis.Delta Med Col J. Jan 2017 5(1): 49-52

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Antiarrhythmika: Welche Rolle spielen sie heute noch?

DMW - Deutsche Medizinische Wochenschrift ◽

10.1055/a-0969-6402 ◽

2020 ◽

Vol 145 (08) ◽

pp. 526-535

Author(s):

Thomas H Fischer

Keyword(s):

Ventricular Arrhythmias ◽

Beta Blockers ◽

Antiarrhythmic Therapy ◽

Term Therapy ◽

Acute Therapy ◽

Cardiac Arrythmias ◽

Antiarrhythmic Medication ◽

Long Term Therapy

AbstractThe use of medical antiarrhythmic therapy apart from beta-blockers has been steadily decreasing in the recent past. This can partly be attributed to technological progress that has rendered the ablation of complex cardiac arrhythmias like atrial fibrillation, focal atrial tachycardias and ventricular arrhythmias feasible and efficacious. Furthermore, an awareness regarding pro-arrhythmic and toxic side-effects of antiarrhythmic medication has evolved. Nevertheless, medical antiarrhythmic therapy still plays a fundamental role in acute therapy of arrythmias as well as certain indications for long-term therapy. This review comprehensively summarizes the current role of medical antiarrhythmic therapy in daily clinical practice focusing on mechanisms and therapies of the most common cardiac arrythmias.

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