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Surgical Outcomes in Patients with Abdominal Cocoon: Series of 15 Patients

  • Harjeet SinghEmail author
  • Santhosh Irrinki
  • Thakur Deen Yadav
  • Hemanth Kumar
  • Jyoti Kharel
  • Narender Dhaka
  • Harshal Mandavdhare
  • Vishal Sharma
Original Scientific Report

Abstract

Background

Abdominal cocoon (AC) or sclerosing encapsulating peritonitis is an uncommon cause of intestinal obstruction. Surgical intervention is warranted in patients with persistent pain or intestinal obstruction.

Methodology

A retrospective analysis of patients operated for AC was performed. Clinical presentation, radiological data, postoperative outcomes (Ryles tube (RT) removal, duration of hospital stay, enterocutaneous fistula, requirement for re-exploration and mortality) were retrieved and analyzed.

Results

Fifteen patients of abdominal cocoon required surgical intervention for various indications. The mean age was 34.46 years (13–60), and 11 (73.3%) were males. Intermittent abdominal pain was present in 14 (93.3%) followed by recurrent subacute intestinal obstruction (SAIO) in 11 (73.3%). Three patients presented with intestinal perforation. Of the 14 patients with preoperative computed tomography, radiological diagnosis was possible in five patients. The mean duration for surgery was 159 min (60–360 min). Membrane encasement was complete in 9/15 and partial in 6/15 patients. Adhesiolysis was done in all patients (complete—10/15 and partial—5/15). Mean duration for RT removal and hospital stay was 4.3 and 12.3 days, respectively. Recurrence of SAIO was observed in three patients, and one patient needed re-exploration for the same. One patient developed postoperative enterocutaneous fistula requiring surgical intervention. Overall mortality in the study was 13.3% (2/15). Four patients had underlying tuberculosis, and the rest were idiopathic.

Conclusion

Etiology of AC is not known in majority of patients. Persistent pain and recurrent SAIO are the most common indications for surgery. This morbidity associated with surgery can be reduced by meticulous dissection techniques and appropriate peri-operative care.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Harjeet Singh
    • 1
    Email author
  • Santhosh Irrinki
    • 2
  • Thakur Deen Yadav
    • 2
  • Hemanth Kumar
    • 2
  • Jyoti Kharel
    • 2
  • Narender Dhaka
    • 3
  • Harshal Mandavdhare
    • 3
  • Vishal Sharma
    • 3
  1. 1.F Block, Nehru Hospital Department of General SurgeryPost Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
  2. 2.Department of General SurgeryPost Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
  3. 3.Department of GastroenterologyPost Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia

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