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Secondary encapsulating peritonitis: a study of cases over five years
Mansoor Banday1, Sehrish Rauof2
1Department of General Surgery, Esi Postgraduate Institute of Medical Sciences and Research and Hospital, Basaidarapur, New Delhi, India.
Objectives:
Cocoon abdomen or sclerosing encapsulating peritonitis is a rare condition characterized by bowel entrapment in a cocoon-like membrane. Primary and secondary types have been described. Most patients present acutely with intestinal obstruction or peritonitis but history of long standing chronic symptoms may be present. The condition is usually not detected on imaging, and diagnosis at laparotomy is common. Surgical treatment includes excision of the membrane with adhesiolysis.
Material And Methods:
A 5-year study of the patients operated for cocoon abdomen in our hospital was conducted. Analysis of patient symptoms, imaging findings, intra-operative findings and histopathology was carried out.
Results:
Five males and three females were included into the study. Mean age was 29.6 years. Five patients presented with acute intestinal obstruction and three patients with perforation peritonitis. Laparotomy was performed in all cases. Successful excision of the membrane was done in all patients of obstruction while membrane excision could only be done in one patient of peritonitis. Histopathology revealed tuberculosis in six patients, one patient was already on anti-tubercular treatment and one patient had carcinoma. There was one mortality.
Conclusion:
Cocoon abdomen is a rare condition. Tuberculosis should always be considered as a cause in endemic areas. Surgery is the preferred treatment and involves excision of the membrane but can be difficult in patients with superadded peritonitis or malignancy.
Insights
Cocoon abdomen, a rare condition causing bowel entrapment, is often diagnosed during surgery. Tuberculosis is a common cause in endemic regions, necessitating surgical membrane excision.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Abdominal Surgery
Background:
- Cocoon abdomen (sclerosing encapsulating peritonitis) is a rare condition involving bowel entrapment within a fibrous membrane.
- It can present acutely with intestinal obstruction or peritonitis, though chronic symptoms may precede acute presentation.
- Diagnosis is often delayed, with imaging rarely identifying the condition, leading to common diagnosis at laparotomy.
Purpose of the Study:
- To analyze patient demographics, clinical presentation, diagnostic findings, and outcomes of cocoon abdomen cases.
- To evaluate the efficacy and challenges of surgical management for cocoon abdomen.
- To identify the underlying etiologies, particularly tuberculosis, in patients with cocoon abdomen.
Main Methods:
- A retrospective 5-year study of patients surgically treated for cocoon abdomen.
- Analysis of clinical symptoms, imaging results, intra-operative findings, and histopathological data.
- Correlation of histopathology with clinical presentation and surgical outcomes.
Main Results:
- Eight patients (5 males, 3 females; mean age 29.6 years) were studied.
- Five patients presented with acute intestinal obstruction, and three with perforation peritonitis.
- Histopathology revealed tuberculosis in six patients; one had carcinoma. Membrane excision was successful in obstruction cases but challenging in peritonitis/malignancy.
Conclusions:
- Cocoon abdomen is a rare surgical emergency, with tuberculosis being a significant cause in endemic areas.
- Surgical excision of the encapsulating membrane is the primary treatment.
- Management can be complex in cases of peritonitis or concurrent malignancy, impacting surgical success and patient outcomes.
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