Rare etiology of mechanical intestinal obstruction: Abdominal cocoon syndrome

Abstract

Abdominal cocoon syndrome is a rare cause of intestinal obstruction with unknown etiology. Diagnosis of this syndrome, which can be summarized as the small intestine being surrounded by a fibrous capsule not containing the mesothelium, is difficult in the preoperative period. A 47-year-old male patient was referred to the emergency department with complaints of abdominal pain, nausea, and vomiting for two days. The abdominal computed tomography examination detected dilated small intestinal loops containing air-fluid levels clustered in the left upper quadrant of the abdomen and surrounded by a thick, saclike, contrast-enhanced membrane. During exploratory surgery, a capsular structure was identified in the upper left quadrant with a regular surface that was solid-fibrous in nature. Abdominal cocoon syndrome is a rarely seen condition, for which the preoperative diagnosis is difficult. The combination of physical examination and radiological signs, and the knowledge of "recurrent characteristics of the complaints" that can be learned by a careful history, may be helpful in diagnosis.

Keywords: Abdominal cocoon syndrome; Adult patient; Intestinal obstruction; Preoperatively diagnosis.

Figure 1

Abdominal radiography, multiple air-fluid levels are seen, which was more prominent in the left upper quadrant.

Figure 2

Abdominal computerized tomography - coronal section; dilated small intestinal loops containing air-fluid levels clustered in the left upper quadrant of the abdomen and surrounded by a thick, saclike, contrast-enhanced membrane in the sections close to the root of mesentery (white arrows). A: Superior; B: Inferior.

Figure 3

Abdominal computerized tomography - coronal section; dilated small intestinal loops containing air-fluid levels clustered in the left upper quadrant of the abdomen and surrounded by a thick, saclike, contrast-enhanced membrane (A) (arrow). The left kidney was also located ectopically at the midline in the abdomen at the level of the pelvis (B) (arrow).

Figure 4

Intraoperative findings; small intestine could not be seen, a capsular structure was identified in the upper left quadrant with a regular surface that was solid-fibrous in nature.