PMC6584983_01
a: Plain upright abdominal X-ray showed some air in the colon without presence of multiple air fluid levels in the loops or free gas under the diaphragm; b, c: Contrast-enhanced computed tomogram scan revealed dilatation of the duodenum loops (*) and congregated small gut loops (black arrowhead) trapped in the massive ascites surrounded by a membrane (white arrowhead)
13756_2019_562_Fig1_HTML.jpg
PMC6584983_01_13756_2019_562_Fig1_HTML.jpg
Fig1
Plain upright abdominal X-ray showed some air in the colon without presence of air fluid levels in the loops or free gas under the diaphragm (Fig. 1a). Contrast-enhanced computed tomogram (CT) of the abdomen (Fig. 1b, c) revealed dilatation of the duodenum loops (*) and congregated small gut loops (black arrowhead) trapped in the massive ascites surrounded by a membrane (white arrowhead).
a: CT scan showed the presence of well-encapsulated fluid collection and central accumulation of the small intestine; b, c: CT scan revealed smudged appearance of the greater omentum (*), as well as multiple small nodules and sheetlike lesions on the parietal peritoneum (arrowhead); d: Laparoscopy demonstrated that the entire small bowel was encapsulated in a dense, white, fibrous, cocoon-like membrane associated with a large amount of brownish ascites. Multitudinous miliary nodules or ubercles were seen on the parietal peritoneum
13756_2019_562_Fig2_HTML.jpg
PMC6584983_01_13756_2019_562_Fig2_HTML.jpg
Fig2
In addition, despite the presence of well-encapsulated fluid collection and central accumulation of the small intestine (Fig. 2a), CT scan also revealed smudged appearance of the greater omentum (Fig. 2b,*), as well as multiple small nodules and sheetlike lesions on the parietal peritoneum (Fig. 2. s, arrowhead), which the radiologists considered to be peritoneal carcinomatosis (PC). Diagnostic laparoscopy was performed in our patient, and the entire small bowel was found to be encapsulated in a dense, white, fibrous, cocoon-like membrane filled with a large amount of brownish ascites (Fig. 2d).
a: CT scan showed the small bowel wall thickening and membrane covering the small bowels (arrowhead), and the ascites has greatly diminished; b: Gastrografin meal follow through study revealed adherent small bowel loops with delayed transit time
13756_2019_562_Fig3_HTML.jpg
PMC6584983_01_13756_2019_562_Fig3_HTML.jpg
Fig3
Though a repeat CT scan of the abdomen and pelvis continued to show the small bowel wall thickening and membrane covering the small bowels (Fig. 3a, arrowhead), and gastrografin meal follow through study revealed adherent small bowel loops with delayed transit time (Fig. 3b), however, the ascites has greatly diminished and the patient was functioning normally.