Abdominal cocoon: clinical presentation, diagnosis, and management

Abstract

A 15-year-old girl presented with features suggestive of sub-acute intestinal obstruction (SAIO) with a palpable abdominal lump. Contrast-enhanced computed tomogram (CECT) abdomen revealed congregated small gut loops confined to a single area and encased in a thick membrane suggestive of abdominal cocoon. On laparotomy, a thick white membrane was found encasing most of the small gut. The cocoon was excised releasing the encased small bowel. The patient was relieved of her symptoms following surgery. Histopathology of excised cocoon membrane revealed granulomatous inflammation consistent with tuberculosis. The patient was discharged on ninth postoperative day with advice to take anti-tuberculosis drugs for 6 months. The possibility of abdominal cocoon should be considered in patients with SAIO and abdominal lump. Abdominal cocoon being a rare condition, CECT is useful in clinching the diagnosis and planning elective surgery in experienced hands.