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Idiopathic sclerosing encapsulating peritonitis (or abdominal cocoon): a report of 5 cases
Ping Xu1, Li-Hua Chen, You-Ming Li
1Department of Gastroenterology, First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road 79, Hangzhou 310003, Zhejiang Province, China.
Abstract:
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.
Insights
Sclerosing encapsulating peritonitis (SEP), or abdominal cocoon, causes intestinal obstruction. Characteristic CT findings aid diagnosis, and surgery is crucial for management.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Sclerosing encapsulating peritonitis (SEP) is a rare condition causing intestinal obstruction.
- It presents as a fibrotic membrane encasing the small bowel, classified as idiopathic (abdominal cocoon) or secondary.
- Pre-operative diagnosis of SEP is challenging.
Observation:
- This study retrospectively reviewed five cases of abdominal cocoon.
- Patients presented with acute, subacute, or chronic intestinal obstruction.
- Computed tomography (CT) revealed characteristic findings in four cases: centrally congregated small bowel loops within a soft-tissue mantle.
Findings:
- Four patients experienced an uneventful post-operative recovery.
- One patient required a second adhesiolysis due to persistent ileus.
- Imaging techniques, particularly CT, show promise in facilitating pre-operative diagnosis.
Implications:
- Early and accurate diagnosis of SEP is critical for effective management.
- Surgical intervention remains a key component in treating abdominal cocoon syndrome.
- Further research into diagnostic modalities and treatment strategies for SEP is warranted.
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