Abdominal cocoon as a rare cause of small bowel obstruction in an elderly man: report of a case and review of the literature

Abstract

Abdominal cocoon is a rare cause of intestinal obstruction usually diagnosed incidentally at laparotomy. The cause and pathogenesis of the condition have not been elucidated. It primarily affects adolescent girls living in tropical and subtropical regions. Several earlier cases have been reported in males. We describe an 82-year-old man presenting with small bowel obstruction without history of previous abdominal surgery. He was treated by warfarin following aortic valve replacement. Abdominal cocoon was detected at laparotomy. Excision of membrane and lysis of adhesions led to relief of obstruction. Abdominal cocoon is a rare pathology that may be found in all kinds of populations. It may be a rare form of small bowel obstruction diagnosed during surgery in elderly patients.

Keywords: Abdominal cocoon; Adults; Encapsulating peritonitis; Intestinal obstruction; Sclerosing peritonitis.

Fig. 1

Abdominal plan film shows small bowel obstruction

Fig. 2

Gastrograffin swallow shows stop in jejunum 2 hours later

Fig. 3

Histology of the membrane revealed hyalinized fibro-adipose tissue with vascular congestion