Hiatus Hernia, Small Bowel Obstruction and Haemorrhoids: a Rare Presentation of Abdominal Cacoon Syndrome(Journal Article)
Abdominal cacoon or Encapsulating Sclerosing peritonitis involves having intra-abdominal organs being surrounded by a dense fibrous, collagenous tissue creating a cacoon [1]. It’s a rare cause of intestinal obstruction with less than 150 cases reported, its etiology is less known however it has been linked to inflammatory disease like Tuberculosis and pelivic inflammatory disease, history of previous abdominal surgery [2-5]. Previous studies reported cases primarily involving young females, but a number of cases involving middle age and elderly men are being reported [2]. While Hiatus hernia is caused by increased intra-abdominal pressure which leads to protrusion stomach and other abdominal viscera into the mediastinum which leads to symptoms of heart burn, vomiting, epigastric and retrosternal Chest pain [6]. Its classified into types I –IV, with type 1 being sliding hiatus hernia, type II para-oesophageal hernia, type III the existence of both type I and II and type IV consisting of other structures herniating into the mediastinum other than the stomach [7,8]. The risk factors have been shown to include pregnancy, skeletal abnormalities and previous gastric surgery. Diagnosis is usually made by barium studies, esophagogastroduodenoscopy, computerized tomography and high resolution manometry. Hemorrhoid disease has long been associated with increased abdominal pressure, constipation and straining on defecation which leads to disintegration and increased shearing forces on the supporting tissues of anal cushions [4]. This results into engorgement of haemorrhoidal plexus and prolapse. We therefore present a case which had all the above pathological entities as seen in our setting
Authoured by: Francis Basimbe
Academic units: Mother Kevin Post Graduate Medical School