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• W3205113743 abstract "A 75-year-old man with a history of alcoholic cirrhosis presented to the emergency department with 7 days of constant, worsening abdominal pain. The patient was afebrile, and physical examination demonstrated jaundice with diffuse tenderness to palpation of the abdomen. Laboratory analysis demonstrated a total bilirubin of 2.9 mg/dL (49.6 μmol/L), indirect bilirubin of 1.9 mg/dL (32.5 μmol/L), aspartate transaminase of 149 U/L (2.5 μKat/L), and alanine transaminase of 5 U/L. A computed tomography (CT) scan of the abdomen was performed (Figure 1, Figure 2).Figure 2Computed tomography of the abdomen (sagittal view) demonstrating an enhancing membrane (arrows) encasing a cluster of thickened small bowel (arrowhead).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Abdominal cocoon sign. Abdominal cocoon sign is a result of encapsulating peritoneal sclerosis. Given its rarity, the incidence rates of encapsulating peritoneal sclerosis vary widely and have been reported from 0.5% to 17.2%. On CT, it is characterized by a cluster of thickened or dilated loops of small bowel surrounded by a fibrous, encapsulating membrane1Singhal M. Krishna S. Lal A. et al.Encapsulating peritoneal sclerosis: the abdominal cocoon.Radiographics. 2019; 39: 62-77Crossref PubMed Scopus (25) Google Scholar as though it were within a cocoon. In addition to idiopathic forms, there are numerous, multifactorial etiologies such as cirrhosis, peritoneal dialysis, and any irritation of the peritoneum2Danford C.J. Lin S.C. Smith M.P. et al.Encapsulating peritoneal sclerosis.World J Gastroenterol. 2018; 24: 3101-3111Crossref PubMed Scopus (41) Google Scholar, resulting in stimulation of collagen formation and fibrosis.2Danford C.J. Lin S.C. Smith M.P. et al.Encapsulating peritoneal sclerosis.World J Gastroenterol. 2018; 24: 3101-3111Crossref PubMed Scopus (41) Google Scholar, 3Jagirdar R.M. Bozikas A. Zarogiannis S.G. et al.Encapsulating peritoneal sclerosis: pathophysiology and current treatment options.Int J Mol Sci. 2019; 20: 5765Crossref Scopus (26) Google Scholar Patients present with nonspecific symptoms such as abdominal pain, constipation, and vomiting. Physical examination may reveal a palpable mass, representing the encapsulated small bowel.1Singhal M. Krishna S. Lal A. et al.Encapsulating peritoneal sclerosis: the abdominal cocoon.Radiographics. 2019; 39: 62-77Crossref PubMed Scopus (25) Google Scholar, 4Brown E.A. Bargman J. van Biesen W. et al.Length of time on peritoneal dialysis and encapsulating peritoneal sclerosis—Position paper for ISPD: 2017 update.Perit Dial Int. 2017; 37: 362-374Crossref PubMed Scopus (68) Google Scholar Given the nonspecific symptoms, there is an exhaustive list of differential diagnoses. There are no specific laboratory tests for encapsulating peritoneal sclerosis and diagnosis is primarily suggested by imaging. Although ultrasound, magnetic resonance imaging, and fluoroscopy can demonstrate findings of encapsulating peritoneal sclerosis, CT is the mainstay imaging choice.1Singhal M. Krishna S. Lal A. et al.Encapsulating peritoneal sclerosis: the abdominal cocoon.Radiographics. 2019; 39: 62-77Crossref PubMed Scopus (25) Google Scholar, 2Danford C.J. Lin S.C. Smith M.P. et al.Encapsulating peritoneal sclerosis.World J Gastroenterol. 2018; 24: 3101-3111Crossref PubMed Scopus (41) Google Scholar Conservative management includes cessation of any inciting causes. Medications such as immunosuppressants and tamoxifen may be of benefit. Surgical management is indicated with overt signs of obstruction or ischemia.3Jagirdar R.M. Bozikas A. Zarogiannis S.G. et al.Encapsulating peritoneal sclerosis: pathophysiology and current treatment options.Int J Mol Sci. 2019; 20: 5765Crossref Scopus (26) Google Scholar, 4Brown E.A. Bargman J. van Biesen W. et al.Length of time on peritoneal dialysis and encapsulating peritoneal sclerosis—Position paper for ISPD: 2017 update.Perit Dial Int. 2017; 37: 362-374Crossref PubMed Scopus (68) Google Scholar" @default.
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• W3205113743 date "2021-11-01" @default.
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• W3205113743 title "Male with Diffuse Abdominal Pain" @default.
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• W3205113743 doi "https://doi.org/10.1016/j.annemergmed.2021.05.001" @default.
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