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. 2013;4(11):955-7.
doi: 10.1016/j.ijscr.2013.08.004. Epub 2013 Aug 20.

Abdominal cocoon-A rare cause of intestinal obstruction

Digvijoy Sharma  1 , Rajesh Parameshwaran Nair, Tushar Dani, Prashanth Shetty
Affiliations

Abdominal cocoon-A rare cause of intestinal obstruction

Digvijoy Sharma et al. Int J Surg Case Rep. 2013.

Abstract

Introduction: Abdominal cocoon syndrome is characterized by small bowel encapsulation by a fibro-collagenous membrane or "cocoon". It is a rare cause of intestinal obstruction.

Presentation of case: A 42-year old man presented with sub-acute intestinal obstruction. Intra-operatively, the entire small bowel was found to be encapsulated in a dense fibrous sac. The peritoneal sac was excised, followed by lysis of the inter-loop adhesions. Postoperative recovery was unremarkable.

Discussion: Most patients with abdominal cocoon syndrome present with features of recurrent acute or chronic small bowel obstruction secondary to kinking and/or compression of the intestines within the constricting cocoon. An abdominal mass may also be present due to an encapsulated cluster of dilated small bowel loops.

Conclusion: Abdominal cocoon is a rare condition causing intestinal obstruction and diagnosis requires a high index of suspicion because of the nonspecific clinical picture. CECT of the abdomen is a useful radiological tool to aid in preoperative diagnosis. Peritoneal sac excision and adhesiolysis is the treatment and the outcome is usually satisfactory.

Keywords: Sclerosing encapsulating peritonitis; Subacute intestinal obstruction.

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Figures

Fig. 1a
Fig. 1a
CECT abdomen (Axial section) showing enhancing sac with small bowel as content.
Fig. 1b
Fig. 1b
CECT abdomen (Sagittal section) showing small bowel encapsulation.
Fig. 2a
Fig. 2a
Intraoperative image showing the sac containing small bowel.
Fig. 2b
Fig. 2b
Excised sac.
See this image and copyright information in PMC

References

    1. Cambria R.P., Shamberger R.C. Small bowel obstruction caused by the abdominal cocoon syndrome: possible association with LeVeen shunt. Surgery. 1984;95:501–503. - PubMed
    1. Deeb L.S., Mourad F., El-Zein Y., Uthman S. Abdominal cocoon in a man: preoperative diagnosis and literature review. Clin Gastroenterol. 1998;26:148–150. - PubMed
    1. Owtschinnikow P.J. Peritonitis chronic fibrosaincapsulata. ArchKlinChir. 1907;83:623–624. [Cited by: Constantinides F, Di Nunno N, Bernasconi P, Jonjic N, Melato M. A new type of peritoneal encapsulation of the small bowel. Am J Surg Pathol 1998; 22: 1297–98]
    1. Foo K.T., Ng K.C., Rauff A., Foong W.C., Sinmah R. Unusual small intestinal obstruction in adolescent girls: the abdominal cocoon. Br J Radiol. 1978;65:427–430. - PubMed
    1. Sieck J.O., Cowgill R., Larkuothy W. Peritoneal encapsulation and abdominal cocoon case reports and a review of the literature. Gastroenterology. 1983;84:1597–1601. - PubMed

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