Abdominal cocoon in children: A case report and review of literature
Daniel Keese1, Andrea Schmedding1, Kerstin Saalabian1
1Goethe-University Frankfurt, Department of Paediatric Surgery and Paediatric Urology, University Hospital, Frankfurt 60590, Germany.
Insights
Encapsulating peritoneal sclerosis (EPS) is a rare cause of intestinal obstruction, particularly in children. This case highlights EPS in a 12-year-old boy post-surgery, emphasizing diagnostic and surgical considerations.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Pathology
Background:
- Encapsulating peritoneal sclerosis (EPS) is a rare condition causing intestinal obstruction, often seen in young females in tropical regions.
- It is typically associated with viral peritonitis, retrograde menstruation, or peritoneal dialysis.
- Most patients present with abdominal pain due to subacute bowel obstruction.
Observation:
- A 12-year-old boy developed EPS eight weeks after surgery for jejunal angiodysplasia.
- The patient had no history of peritoneal dialysis or specific drug intake.
- Imaging findings for EPS are often nonspecific.
Findings:
- EPS involves the encasement of the small intestine within a thick fibrocollagenous membrane.
- This membrane restricts bowel motility, leading to obstruction.
- Histopathological examination is crucial for definitive diagnosis.
Implications:
- This case broadens the understanding of potential causes and patient demographics for EPS.
- Highlights the importance of considering EPS in pediatric patients with unexplained abdominal obstruction post-surgery.
- Emphasizes the need for a multidisciplinary approach involving diagnostic, surgical, and pathological expertise for managing EPS in children.
Background:
Abdominal cocoon or "encapsulating peritoneal sclerosis" (EPS) is an uncommon and rare cause of intestinal obstruction. Only a few cases have been reported in paediatric patients. Typically, EPS is described as the primary form in young adolescent girls from tropical and subtropical countries because of viral peritonitis due to retrograde menstruation or a history of peritoneal dialysis. Most patients are asymptomatic or present with abdominal pain, which is likely to occur secondary to subacute bowel obstruction. Findings at imaging, such as ultrasound, computed tomography, and magnetic resonance imaging, are often nonspecific. When diagnosed, EPS is characterized by total or partial encasement of the bowel within a thick fibrocollagenous membrane that envelopes the small intestine in the form of a cocoon because of chronic intraabdominal fibroinflammatory processes. The membrane forms a fibrous tissue sheet that covers, fixes, and finely constricts the gut, compromising its motility.
Case Summary:
We present a case of EPS in a 12-year-old boy 8 wk after primary surgery for resection of symptomatic jejunal angiodysplasia. There was no history of peritoneal dialysis or drug intake.
Conclusion:
In this report, we sought to highlight the diagnostic, surgical, and histopathological characteristics and review the current literature on EPS in paediatric patients.
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