Idiopathic-abdominal-cocoon—a-rare-cause-of-small-bowel-obstruction

The idiopathic form of sclerosing encapsulating peritonitis, also known as abdominal cocoon, is a rare entity of unknown cause that leads to intestinal obstruction due to complete or partial encapsulation of the small intestine by a fibro- collagenous membrane. As the initial clinical features are non-specific, they often remain unrecognized making it difficult to make a definite pre-operative diagnosis. Recurrent episodes of small intestinal obstruction along with relevant imaging findings and lack of other causative mechanisms, gives rise to a clinical suspicion. We report a young lady who presented to us with features suggestive of acute intestinal obstruction. Thorough enquiry revealed similar episodes on multiple occasions in the past which was temporarily relieved with conservative management. The need to keep an open mind regarding the uncommon causes of commonly encountered problems is the point of interest in our case.

The diagnosis and treatment of abdominal cocoon in 8 cases / 中华普通外科杂志

Objective:To evaluate the diagnosis and treatment of abdominal cocoon.Methods:The clinical data of 8 patients with abdominal cocoon in our hospital from Jan 2015 to Dec 2021 were retrospectively reviewed including clinical and imaging manifestations, treatment and follow-up.Results:One case was asymptomatic, and the other 7 cases suffered from recurrent abdominal pain with complete or incomplete intestinal obstruction. The median course of disease was 6 months (15 days to 40 years). Six cases underwent laparcoscopic cocoon membrane resection and intestinal adhesion lysis, of which 2 cases underwent laparotomy, one case was converted to open surgery, 4 cases underwent concomitant appendectomy. Follow-up ranged from 3 to 69 months, there were 2 cases complicating early inflammatory intestinal obstruction, 1 case suffred wound fat liquefaction and infection, 1 case with a colic 5 months after operation, and the others were doing well.Conclusions:The clinical characteristics of abdominal cocoon disease are not typical. Surgery is the main treatment. The prognosis of the disease is generally fair.

IgG4 related sclerosing encapsulating peritonitis with cocoon formation: An unusual and undescribed presentation

IgG4-related sclerosing mesenteritis is a rare disease of mesentery of an unknown etiology which shows a constellation of histopathologic findings of lymphoplasmacytic inflammation with IgG4-positive plasma cells and marked fibrosis. This chronic inflammatory condition of mesentery forming an abdominal cocoon has never been described before to the best of our knowledge. Here, we report a patient with a history of subacute small bowel obstruction who was found to have an intra-abdominal encapsulating mass in the right iliac fossa and was finally diagnosed as IgG4-related sclerosing encapsulating peritonitis (abdominal cocoon) based on peroperative findings, histology and immunohistochemistry.

An Unusual Cause of Intestinal Obstruction: Abdominal Cocoon

ABSTRACT Abdominal cocoon syndrome is a rare cause of intestinal obstruction, which is difficult to diag- nose preoperatively. We here report a case of abdominal cocoon. A 47-year-old male patient was referred to the general surgery department with complaints of abdominal pain, distension, nausea and vomiting for 1 day. An abdominal computed tomography examination detected the dilated small intestinal loops clustered in the abdomen and surrounded by a sac-like membrane. During the exploratory surgery, a capsular structure was identified in the lower quadrant with a regular surface that was solid fibrous in nature. The combination of physical examination, imaging signs and medical history may be helpful in the diagnosis.

Surgical management of abdominal tuberculosis in a tertiary care referral center

Background: Abdominal tuberculosis encompasses gastrointestinal, visceral and peritoneal forms of tuberculosis in different proportions. Their clinical presentation and radiological findings are varied and non-specific often warranting surgical intervention either for confirmation of diagnosis or for definitive management.  It is not very clear as of now as to which type of patients would require surgical intervention for diagnosis or treatment of abdominal tuberculosis. This study aims to profile such patients accurately to revalidate the need for surgical intervention in cases of abdominal tuberculosis.Methods: This study is a retrospective descriptive observational study wherein the documents of patients whose final diagnosis was confirmed as ‘Abdominal Tuberculosis’ from January 2011 to December 2013 were analysed. Their demographic and clinical profile, hematological, biochemical and radiological investigations including barium meal follow-through, ultrasonography, CT scan abdomen, colonoscopy and biopsy, HIV status and ascitic fluid analysis were analysed. Patients in whom diagnosis was not confirmed by these investigations, and therefore underwent diagnostic laparoscopy or exploratory laparotomy were studied. Simultaneously, patients in whom, the diagnosis was confirmed, but still underwent surgical intervention for therapeutic purposes were also analysed.Results: It was found that 44 out of 54 patients (81.4%) underwent surgical procedure.  28 (52%) required surgical intervention for confirmation of diagnosis (diagnostic procedures: diagnostic laparoscopy- 21 and exploratory laparotomy- 07) while 16 (29.4%) required therapeutic procedures (emergency- 08; elective- 08).Conclusions: In spite of extensive investigations, many patients of abdominal tuberculosis require surgical management either minimally invasive or otherwise, both for confirmation of diagnosis and for definitive management.

Peritonitis esclerosante primaria y secundaria: estudio comparativo / Primary and secondary sclerosing peritonitis: comparative study

Resumen Introducción: Existen dos tipos de peritonitis esclerosante (PE): primaria o idiopática y secundaria, generalmente a diálisis peritoneal (DP), y con menor frecuencia a otras patologías abdominales o sistémicas. Su mortalidad es alta. Objetivo: Comparar las características clínicas, estudios diagnósticos y tratamiento de pacientes con Peritonitis Esclerosante Primaria y Secundaria, definir si existen diferencias y determinar los principales elementos clínicos e imagenológicos que permitan hacer un diagnóstico precoz y mejorar los resultados terapéuticos. Material y Métodos: Se analizan 18 casos de PE diagnosticados en nuestro hospital, entre los años 2001-2014. Incluye una serie retrospectiva de 15 casos de PE secundaria (13 por diálisis peritoneal y 2 por cirrosis hepática). Se compara con un estudio prospectivo que incluye 3 pacientes con PE primaria. Resultados: Las principales diferencias se evidencian en la presentación clínica: PE primaria: se presenta con cuadro de obstrucción intestinal y baja de peso de distinta magnitud. PE secundaria: predominan el dolor abdominal, peritonitis recurrente y la falla de ultrafiltración. La tomografía computada de abdomen es útil, sobre todo cuando hay obstrucción intestinal. Ha hecho posible el diagnóstico preoperatorio. Conclusiones: Se requiere un alto índice de sospecha para el diagnóstico precoz de PE, sobre todo para la forma primaria. Debe sospecharse en todo paciente con dolor abdominal, vómitos recurrentes y baja de peso de cualquier magnitud; y en aquellos en diálisis peritoneal durante 5 años o más, que presenten dolor abdominal y/o peritonitis recurrente y/o falla de ultrafiltración.

Introduction: There are two types of sclerosing peritonitis (SP): primary or idiopathic and secondary, generally to peritoneal dialysis, and less frequently, to other abdominal or systemic pathologies. Mortality related to this is high. Objective: To compare the clinical feature, diagnostic studies and treatment of patients with Primary and Secondary Sclerosing Peritonitis, to define whether there are any differences and to establish the main clinical and imaging elements allowing for an early diagnosis and improving the therapeutic results. Material and Methods: An analysis of 18 SP cases diagnosed at our hospital between 2001-2014 was carried out. This includes a retrospective series of 15 cases of secondary SP (13 to peritoneal dialysis and 2 to liver cirrhosis). This is compared against a prospective study that includes 3 patients with primary SP. Results: The main differences became evident in the clinical presentation: Primary SP: occurs in an intestinal obstruction and a loss of weight scenario of varying degrees. Secondary SP: abdominal pain and recurrent peritonitis as well as ultrafiltration failure prevail. CT of the abdomen has proven to be useful, in particular in those cases where there is intestinal obstruction. It has made preoperative diagnostic possible. Conclusions: A high degree of suspicion is required for an SP early diagnosis, especially for the primary form. All patients presenting abdominal pain, recurrent vomiting and any degree of weight loss and those with five or more years of peritoneal dialysis presenting abdominal pain and/or recurrent peritonitis and/or ultrafiltration failure should raise a diagnosis suspicion.

Comparison of chemical constituents of wild silkworm cocoon and domestic silkworm cocoon by UHPLC-MS technology / 生物工程学报

Identifying and comparing the chemical constituents of wild silkworm cocoon and silkworm cocoon is of great significance for understanding the domestication of silkworm. In this study, we used high temperature and high pressure and methanol-water system to extract cocoon chemical constituents. We used UHPLC-MS to identify and compare cocoon chemical constituents of wild silkworm and domestic silkworm Dazao and Haoyue strains. The cocoon metabolic fingerprints of wild silkworm and domestic silkworm Dazao and Haoyue strains were obtained by using the UHPLC-MS in the positive ion mode and negative ion mode. By annotation, we found that cocoon chemical compounds with high abundances contained amino acids, flavonoids, alkaloids, terpenes, organic acids, and lignans. PLS-DA showed that the cocoon components were significantly different among the wild silkworm and two domestic silkworm strains Dazao and Haoyue. Proline, leucine/isoleucine and phenylalanine showed significantly higher abundances in the cocoon of domestic silkworm Dazao strain than in those of wild silkworm and domestic silkworm Haoyue strain. The flavonoid secondary metabolites are abundant in the Dazao cocoon, including quercetin, isoquercetin, quercetin 3-O-sophoroside, quercetin-3-O-α-L-rhamnoside, quercetin-3-O- rutinoside, and kaempferol. The other secondary metabolites, alkaloids, terpenes and lignans, showed higher abundances in the wild silkworm cocoon than in the domestic silkworm cocoon, including neurine, candicine, pilocarpidine, artemisiifolin, eupassopin, and eudesobovatol. By exposing cocoons to UV light and observing the green fluorescence of flavonoids, we found that Dazao cocoon had the most flavonoids, and Haoyue cocoon had least flavonoids and wild silkworm cocoon had mediate flavonoids. Alkaloids and organic acids are good anti-insect and antimicrobial agents, which have high abundance in the wild silkworm cocoon and could enhance the defense ability of wild silkworm cocoon. Flavonoids are abundant in the cocoon of domestic silkworm Dazao strain, which the main factors are leading to the yellow-green cocoon of Dazao.

Idiopathic abdominal cocoon: An enigma

Abdominal cocoon is often described by various terminologies like encapsulating peritoneal sclerosis (EPS) or sclerosing encapsulating peritonitis or peritonitis chronica fibrosa incapsulata is defined as syndromes associated with symptoms due to formation of a fibro-collagenous peritoneal membrane involving commonly the small intestinal loop. Clinical presentation ranges from abdominal pain to features of intestinal obstruction which may be acute or sub-acute. It is believed to be mesenchymal transition of mesothelial cells. This condition is commonly associated with tuberculosis, peritoneal dialysis and previous abdominal surgeries but may also be idiopathic. Though a wide range of medical management has been tried for conservative management of the patient, surgery is the preferred choice of treatment to alleviate the persisting symptoms. This is one condition where on table intra op diagnosis supersedes the imaging and histological diagnosis. Here, we discuss the case report of 32 year old male, known diabetic for 4 years, who presented with complaints of abdominal pain, intermittent for over 5 years, with no evidence of intestinal obstruction. Imaging showed abdominal cocoon of small bowel loops and mid gut rotation anomaly with internal hernia. Laparoscopically the cocoon sac was removed and adhesiolysis was done. This case report is to add richness to limited amount literary resources available about abdominal cocoon syndrome.

Research advances on diagnosis and treatment of abdominal cocoon / 中华消化外科杂志

Abdominal cocoon is a rare,peritoneal disease with a disorder of the autoimmune system.It is a disease of acute and chronic intestinal obstruction caused by a thickened peritoneum that wraps or partially wraps the small intestine.The cause and mechanism of its etiology are not yet fully understood which need further study.The clinical features of the abdominal cocoon symptoms are lack of specificity,which can easily lead to misdiagnosis and missed diagnosis.There is no perfect treatment standard for treatment.With the promotion and popularization of CT,Iaparoscopic and other technologies,the diagnosis and treatment of abdominal cocoon symptoms can be improved.Although conservative treatment can delay the progression of abdominal cocoon symptoms,it still cannot solve the problem fundamentally.Surgical treatment is still the best choice for patients with abdominal cocoon.

Abdominal cocoon: A roport of 5 cases / 中华普通外科杂志

Objective To explore the clinical characteristics and treatment of abdominal cocoon.Methods Clinical data of 5 cases with abdominal cocoon in our hospital from October 2015 to February 2017 were analyzed.Results 5 patients with abdominal cocoon were recruited,including 3 males and 2 females.Of the 5 patients,one with gastric cancer,1 with colon cancer,2 with rectal cancer and 1 with cryptorchidism.All the patients have no symptoms of intestinal obstruction.Laparotomy revealed that all or part of small intestine had been wrapped in a layer of tough fibrous membrane.Excision of primary lesion without lysis of adhesions were done.No symptoms of intestinal obstruction and intestinal fistula occurred after operation.Conclusions The preoperative diagnosis of abdominal cocoon is difficult.It is often inadvertently found in the operation,asymptomatic patients,do not need treatment.

Obstrucción intestinal por peritonitis esclerosante encapsulada en un adulto con derivación ventriculoperitoneal / Bowel obstruction caused by sclerosing encapsulating peritonitis in adult with ventriculoperitoneal shunt

Resumen Introducción La peritonitis esclerosante encapsulada es una inflamación crónica del peritoneo caracterizada por la formación progresiva de colágeno que produce un engrosamiento peritoneal que encapsula las asas del intestino delgado, produciendo una obstrucción intestinal. Caso clínico Varón de 83 años portador de catéter de derivación ventriculoperitoneal de baja presión desde hacía 8 años. Acude a Urgencias por clínica de obstrucción intestinal, con hallazgos radiológicos en relación con obstrucción de intestino delgado en probable relación con catéter de derivación ventriculoperitoneal, por lo que se decide realizar intervención quirúrgica urgente. Se confirmó la obstrucción intestinal y un cambio de calibre del íleon terminal. El intestino delgado estaba dilatado formando un ovillo, englobado por una pequeña cápsula fibrosa. Se realizó adhesiólisis y hemicolectomía derecha con resección del segmento intestinal afectado. La anatomía patológica fue compatible con peritonitis esclerosante encapsulada. Conclusiones La peritonitis esclerosante encapsulada es una causa poco frecuente y potencialmente grave de obstrucción intestinal y su forma secundaria está habitualmente asociada a la diálisis peritoneal crónica. Su diagnóstico radiológico es difícil y el tratamiento de elección es quirúrgico. Debemos considerarla en casos de obstrucción intestinal en pacientes portadores de derivación ventriculoperitoneal.

Introduction Sclerosing encapsulating peritonitis is a chronic inflammation of the peritoneum characterized by the progressive accumulation of collagen. This leads to a thickening of the peritoneum, encapsulating loops of small bowel and causing intestinal obstruction. Case report 83 year old male, carrying a ventriculoperitoneal low pressure shunt for 8 years. The patient was admitted for emergency surgery after presentation for possible intestinal obstruction with radiological findings consistent with small bowel obstruction, probably related to the catheter of the ventriculoperitoneal shunt. Surgery confirmed bowel obstruction and a change of gauge of the terminal ileum. The small bowel was dilated into a ball, encased by a small fibrous capsule. Adhesiolysis and right hemicolectomy was performed with resection of the affected bowel segment. The pathology was consistent with sclerosing encapsulating peritonitis. Conclusions Sclerosing encapsulating peritonitis is a rare and potentially serious cause of bowel obstruction and its secondary form is usually associated with chronic peritoneal dialysis. The radiological diagnosis is difficult and the treatment of choice is surgical. We must consider it in cases of intestinal obstruction in patients with ventriculoperitoneal shunt.

Preventing Pertussis in the Early Infant: Development and Results of a Prenatal Vaccination Program.

Introduction: Cases of Pertussis increase every year with special morbidity and mortality in early infants. The objective was to evaluate results of a program of vaccination of pregnant women launched in our center in 2013. Methods: This is an observational retrospective study. We reviewed all cases of Pertussis disease in our center (2011-2015) and compared clinical data between two groups of age: Early infants (<3 months of age) and Other Groups (>3 months). We also compared perinatal events in vaccinated versus non vaccinated pregnant women. Results: During the period 2011-2015, 63 cases (9 in Early Infants; 54 Other Groups) were treated. All cases in Early Infants required hospitalization (100% vs. 3,70%; p<0,05) with more days of hospitalization (10,2 days vs. 0,36 days; p<0,05) and need of oxygen (66,67% vs.3,70%; p<0,05). No differences were seen in response to Azithromycin (87,5% vs. 97,91%; p>0.05) nor in incidence in close relatives (44,44% vs. 27,45%; p>0,05). No differences were observed in Perinatal events in vaccinated vs. non vaccinated in terms of duration of pregnancy (279 days vs. 278 days; p>0,05), weight at birth (3290gr vs. 3220gr; p>0,05), admission at NICU (1,58% vs.1,87%; p>0,05) and Apgar test score <7 at 5 minutes (0,27% vs. 0%; p>0,05). Proportion in early infants affected lowered from 40% in 2011 to 3,85% in 2015. Conclusions: Maternal immunization with Tdap vaccine seems to be a good strategy to reduce incidence of pertussis in the offspring. Additional measures such as vaccinating relatives should be considered.

Idiopathic Sclerosing Encapsulating Peritonitis Revealed by Intestinal Obstruction.

Sclerosing encapsulating peritonitis (SEP) is a very rare entity characterized by encasement of small intestine by a fi­brocollagenous membrane. It is divided into primary (idiopathic) which is named as abdominal cocoon and secondary forms. The preoperative diagnosis is difficult and most cases are diagnosed intraoperatively. A conservative treatment approach is the most suitable management strategy in asymptomatic idiopathic SEP. In this paper, we aimed to present a case of idiopathic SEP revealed by intestinal obstruction.

Computed tomography features of small intestinal obstruction caused by primary abdominal cocoon / 中华消化外科杂志

Objective To summarize the computed tomography (CT) features of small intestinal obstruction caused by primary abdominal cocoon and investigate the essentials of diagnosis and differential diagnosis.Methods The retrospective descriptive study was adopted.The clinical data of 1 patient with small intestinal obstruction caused by primary abdominal cocoon who was admitted to the Second Affiliated Hospital of Jiaxing University on October 6,2014 were collected.The patient underwent abdominal CT on admission and at 10 hours after admission.The patient received emergency exploratory laparotomy after preoperative preparation,and then postoperative regular symptomatic treatment and pathological examination.Results of abdominal CT were observed,including imaging features of abdominal masses,extent of small intestinal obstruction,situation of intestinal tube within the masses,vessel distribution in the mesentery and fibrous capsules around the mesentery.Situation of operation,routine blood test,biochemical indicator,blood coagulation indexes,postoperative recovery,complications,results of pathological examination and situation of patient during follow-up were recorded.The follow-up by telephone interview and outpatient examination was applied to the patient till October 31,2015,including detecting the dietary,with or without symptoms of abdominal pain and distension,haematemesis and hematochezia,routine blood retest,liver function,renal function and CT.Results Results of abdominal CT on admission:(1) coronal plain scan of abdominal CT showed that there were signs of incomplete intestinal obstruction,and local small intestinal dilatation and gas accumulation in left abdominal region without specific sign.(2) Plain scan of abdominal CT showed that there were the coated sign with thickened fibrous capsules around the intestinal tube, banana shape ' with agglomerate and expanding-distortion intestinal tube and aggregative,stretching and twisting mesentery with abnormal vessel distribution.(3) Sagittal reconstruction images of abdominal CT showed that a huge mass consisted of fibrous capsules as cocoon and agglomerate and expanding-distortion intestinal tube was petal-like and fixed on posterior abdominal wall.(4) Coronal reconstruction images of abdominal CT showed that agglomerate and expanding-distortion intestinal tube was annularly surrounded by uneven thickness fibrous capsules with abnormal vessel distribution in the mesentery.Results of abdominal CT at 10 hours after admission:(1) coronal plain scan of abdominal CT showed that small intestinal obstruction was obviously exacerbated and expanding intestinal tubes were increased and aggravated.(2) Plain scan of abdominal CT showed that a typical sign of small intestinal obstruction was exacerbated and there were multiple air-fluid levels in the agglomerate and expanding-distortion intestinal tube with fluid and gas accumulation.Patient underwent successful enterodialysis + resection of fibrous capsules.During operation,a huge mass in the intestine from suspensory ligament of duodenum to ileocecum was fixed on posterior abdominal wall and surrounded by dense,smooth and white fibrous capsules,partial colon was also surrounded by fibrous capsules and greater omentum was missing.Patient received the postoperative supporting treatments of fasting,anti-infection and inhibition of acid.Number of white blood cells,absolute value and percentage of neutrophils,levels of high-sensitivity C-reactive protein and procalcitonin were 17.10 × 109/L,15.70 × 109/L,91.5％,127.49 mg/L and 1.370 μg/L by blood routine retest at postoperative day 1,respectively.Patient had normal liver,renal and coagulation functions.Fluid diet intake at postoperative week 1 was gradually replaced by normal diet intake.Patient had normal liver and renal functions by blood routine retest at postoperative day 10 and a good recovery without intestinal fistula,abdominal and pulmonary infections and other complications.Postoperative pathological examination showed that gross specimen was mainly composed of cocoon-shaped,grayish white and tough fibrous capsules.Fibrous capsules were consisted of proliferative fibrofatty tissues by microscope observation,with small vascular hyperplasia and large numbers of the inflammatory cell infiltration.Patient was diagnosed with small intestinal obstruction caused by primary abdominal cocoon after operation,and followed up for 1 year with normal diet intake and without abdominal pain and distension,nausea and vomiting,melena and discomfort.There was normal blood routine retest,liver and renal functions and distribution of the intestine in abdomen by CT examination.No dilatation of the intestinal tube was found and strip-like high density shadow in ileocecum was detected and considered as remnant fibrous capsules.Conclusion Imaging features of small intestinal obstruction caused by primary abdominal cocoon include agglomerate and expanding-distortion intestinal tube fixed on abdomen,partial intestinal tubes dilatation,intestinal fluid accumulation and air-fluid level,aggregative,stretching and twisting mesentery with abnormal vessel distribution,thickened fibrous capsules around intestinal loops and among intestinal tubes.

Comparison of unprocessed silk cocoon and silk cocoon middle layer membranes for guided bone regeneration / 대한악안면성형재건외과학회지

BACKGROUND: Silk cocoon is composed of multiple layers. The natural silk cocoon containing all layers was cut as a rectangular shape as defined as total group. The inner and outermost layers were removed from the total group and the remained mat was defined as the middle group. The objectives of this study was to compare the total group with the middle group as a barrier membrane for the guided bone regeneration. METHODS: The effects of these materials on the cellular proliferation and alkaline phosphatase (ALP) expression of MG63 cells were explored. For comparing bone regeneration ability, bilateral bone defects were created in calvarial areas in ten adult New Zealand white rabbits. The defects were covered with silk membranes of the middle group, with silk membrane of the total group used as the control on the contralateral side. The defects were allowed to heal for 4 and 8 weeks. Micro-computerized tomography (μCT) and histological examination were performed. RESULTS: The middle group exhibited a higher MTT value 48 and 72 h after treatment compared to the total group. ALP expression was also higher in the middle group. The results of µCT and histologic examination showed that new bone formation was significantly higher in the middle group compared to the total group 8 weeks postoperatively (P < 0.05). CONCLUSIONS: In conclusion, the middle layer of the silk cocoon supports guided bone regeneration better than unprocessed silk cocoon.

Evaluation of multi-slice spiral CT in diagnosis of abdominal cocoon / 实用放射学杂志

Objective To investigate the value of multi-slice CT in diagnosis of abdominal cocoon.Methods CT findings of six cases with pathologically proved abdominal cocoon were collected and analyzed retrospectively.The three-dimensional imagines were obtained including multi-planar reconstruction(MPR),maximum intensity projection(MIP)and volume rendering(VR)at workstation,the rela-tionships between the lesions and surrounding structure were observed.Results A group of local small intestine were seen gathered in all six cases,the coiled intestine arranged inaccordionshape orbananashape.The fibrous capsule were seen around them with different thickness,which were low density and slightly enhancement.Mesenteric arteries showed abnormal changes,showing ten-sion,aggregation.Conclusion MSCT can provide a wealth of diagnostic information and is the best method of examination abdomi-nal cocoon.

A Pre-Operatively Diagnosed Abdominal Cocoon.

Abdominal Cocoon or idiopathic encapsulating peritonitis is a rare cause of intestinal obstruction. It more commonly occurs in young adolescent girls and the diagnosis is usually made at laparotomy. Recent case reports suggest that it is not uncommon in males and pre-operative diagnosis is possible by radiological investigations. We present a case of abdominal cocoon in an adult male, pre-operatively diagnosed by ultrasound and computerized tomography.

Abdominal cocoon in a young man / 世界急诊医学杂志（英文）

BACKGROUND: Intestinal obstruction remains a common problem encountered in the surgical emergency, and usually occurs secondary to adhesions, obstructed herniae or tubercular strictures. However, at times, rare causes of obstruction can also be encountered. METHODS: A 24-year-old male patient presented with recurrent episodes of intestinal obstruction that was found to be secondary to an abdominal cocoon on laparotomy. RESULTS: The patient underwent adhesiolysis of the cocoon, and remains well on a follow-up. Histopathological report of the cocoon wall revealed fibrocollagenic tissues with a mixed inflammatory infiltrate, without any evidence of tuberculosis. CONCLUSIONS: Abdominal cocoon can be a rare cause of intestinal obstruction in male patients. Adhesiolysis of the cocoon membrane releases the obstruction and gives good results.

Abdominal cocoon: Case report of a rare cause of intestinal obstruction.

Abdominal cocoon or sclerosing encapsulated peritonitis is a rare cause of intestinal obstruction often seen in adolescent girls. We present a case of an abdominal cocoon in a 14-year-old female presenting as a surgical emergency. The patient underwent excision of the involved segment of small bowel along with a part of ascending colon. Gross morphology revealed intestinal coils wrapped within a thick fibrous membrane. Diagnosis of this condition is seldom possible on radiological imaging. Characteristic gross appearance is showcased in our case, to create more awareness of this finding.

Effect of crude extract of Bombyx mori coccoons in hyperlipidemia and atherosclerosis.

The silkworm is the larva or caterpillar of the domesticated silkmoth, Bombyx mori and being a primary producer of silk is an economically important insect. These days the silk is emerging as a resource for solving a broad range of biological problems. The silk (Abresham) is popularly known as Abresham muqriz (muqriz means cut) in Unani medicine. Its cocoons are extensively used as an ingredient of various Unani formulations like Khameer-E- Abresham Sada, Khameere Abresham Hakeem Arshad Wala, Khameere Abresham Ood Mastagi Wala etc. and are used to treat many cardiac and nervous disorders. The hypolipidemic activity of this drug, along with Nepata Hindostana (Badranjboya) and Terminalia Arjuna (Arjan) has been documented. But action of extract of Bombyx mori cocoons as a single drug is not documented. That's why; it was decided to study its effect on hyperlipidemia and atherosclerosis. The Male New Zealand White rabbits all of 1.5kgs were selected for the study. After stabilization period (2 weeks) the rabbits were divided into 3 groups (Group I - Control, Group II Lesion Control and Group III treated with extract of Bombyx mori silk cocoon). Hyperlipidemia and atherosclerosis were induced with 1% cholesterol diet. After induction of hyperlipidemia and atherosclerosis for twelve weeks, Group III rabbits were treated with Bombyx mori for 6 weeks (45 days). A significant decrease in hyperlipidemia was seen within 4 weeks of treatment. Histopathologically, the atherosclerotic plaques showed reduction in size. The third group showed a significant increase in the body weight and also an increase in the HDL cholesterol levels. The study concludes that extract of Bombyx mori cocoons has a significant effect on hypercholesterolemia and atherosclerosis probably because of its antioxidant and hypolipidemic effect.