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Abdominal Cocoon Syndrome
Image of the Month Abdominal Cocoon Syndrome JACQUES MATONE, FERNANDO HERBELLA, and JOSE CARLOS DEL GRANDE Digestive Surgery Division, Department of Surgery, Escola Paulista de Medicina, UNIFESP Rua Napoleão de Barros, São Paulo-SP, Brazil
33-year-old man was admitted with a 2-day history of vomiting and abdominal pain. The patient experienced similar complaints for 1 year with spontaneous relief. His past medical history was unremarkable. Physical examination revealed a mild tenderness and a mass in the lower abdomen. Routine laboratory work-up had no abnormalities. An abdominal radiograph showed dilated smallbowel loops in the right abdomen. Symptoms subsided after a period of clinical management; however, after resuming oral feeding, the symptoms returned. A small-bowel follow-through showed that small-bowel loops were bunched and confined to the lower abdomen and pelvis, and also showed a significant delay in the distal passage of the barium (Figure A). A computed tomography scan of the abdomen and pelvis revealed dilatation of the proximal small-bowel loops and thickening of the peritoneum (Figure B, arrow). At exploratory laparotomy, a globular mass occupied the central abdomen and a considerable length of the small bowel (SB) was encased within a whitish thickened membrane (P) (Figure C). On incising the overleaf of the
A
membrane, the entire small bowel was found coiled in a serpiginous fashion. Histopathologic study of the membrane revealed fibrotic tissue. Abdominal cocoon, also called sclerosing encapsulating peritonitis, is a rare cause of intestinal obstruction, found predominantly in adolescent girls living in tropical and subtropical regions. It is characterized by total or partial encasement of the small bowel in a fibrocollagenous cocoon-like sac.1 Fewer than 50 cases of abdominal cocoon have been reported. Neither the cause nor the pathogenesis has been elucidated fully. Predisposing conditions include chronic ambulatory peritoneal dialysis, previous abdominal surgery, peritonitis, peritoneovenous shunt, tuberculosis, sarcoidosis, systemic lupus erythematosus, practolol therapy, and trauma.2 Most of the reported cases are considered idiopathic.
References 1. Hamaloglu E, Altun H, Ozdemir A, et al. The abdominal cocoon: a case report. Dig Surg 2002;19:422– 424. 2. Dequanter D, Lefebvre JC, Pauw LD, et al. Sclerosing peritonitis: report of three cases. Acta Chir Belg 2003;103:408 – 411.
© 2006 by the American Gastroenterological Association Institute
1542-3565/06/$32.00 doi:10.1016/j.cgh.2005.12.005 CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2006;4:xxxi
33-year-old man was admitted with a 2-day history of vomiting and abdominal pain. The patient experienced similar complaints for 1 year with spontaneous relief. His past medical history was unremarkable. Physical examination revealed a mild tenderness and a mass in the lower abdomen. Routine laboratory work-up had no abnormalities. An abdominal radiograph showed dilated smallbowel loops in the right abdomen. Symptoms subsided after a period of clinical management; however, after resuming oral feeding, the symptoms returned. A small-bowel follow-through showed that small-bowel loops were bunched and confined to the lower abdomen and pelvis, and also showed a significant delay in the distal passage of the barium (Figure A). A computed tomography scan of the abdomen and pelvis revealed dilatation of the proximal small-bowel loops and thickening of the peritoneum (Figure B, arrow). At exploratory laparotomy, a globular mass occupied the central abdomen and a considerable length of the small bowel (SB) was encased within a whitish thickened membrane (P) (Figure C). On incising the overleaf of the
A
membrane, the entire small bowel was found coiled in a serpiginous fashion. Histopathologic study of the membrane revealed fibrotic tissue. Abdominal cocoon, also called sclerosing encapsulating peritonitis, is a rare cause of intestinal obstruction, found predominantly in adolescent girls living in tropical and subtropical regions. It is characterized by total or partial encasement of the small bowel in a fibrocollagenous cocoon-like sac.1 Fewer than 50 cases of abdominal cocoon have been reported. Neither the cause nor the pathogenesis has been elucidated fully. Predisposing conditions include chronic ambulatory peritoneal dialysis, previous abdominal surgery, peritonitis, peritoneovenous shunt, tuberculosis, sarcoidosis, systemic lupus erythematosus, practolol therapy, and trauma.2 Most of the reported cases are considered idiopathic.
References 1. Hamaloglu E, Altun H, Ozdemir A, et al. The abdominal cocoon: a case report. Dig Surg 2002;19:422– 424. 2. Dequanter D, Lefebvre JC, Pauw LD, et al. Sclerosing peritonitis: report of three cases. Acta Chir Belg 2003;103:408 – 411.
© 2006 by the American Gastroenterological Association Institute
1542-3565/06/$32.00 doi:10.1016/j.cgh.2005.12.005 CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2006;4:xxxi