Idiopathic abdominal cocoon syndrome with unilateral abdominal cryptorchidism and greater omentum hypoplasia in a young case of small bowel obstruction

Abstract

Abdominal cocoon syndrome (ACS) is a rare cause of intestinal obstruction due to total or partial encapsulation of the small intestine by a fibrocollagenous membrane. Idiopathic ACS with abdominal cryptorchidism and greater omentum hypoplasia is even rarer clinically. We successfully treated a 26-year-old male case of small bowel obstruction with acute peritonitis. He was finally diagnosed with idiopathic ACS with unilateral abdominal cryptorchidism and greater omentum hypoplasia during exploratory laparotomy. He then underwent enterolysis, cryptorchidectomy, and appendectomy. He recovered gradually from the operations and early postoperative inflammatory ileus. There has been no recurrence of intestinal obstruction since the operation, and he is still in follow-up. We analyzed his clinical data and retrospectively reviewed the literature, and our findings may be helpful for the clinical diagnosis and treatment on ACS.

Keywords: Abdominal cocoon syndrome; Abdominal cryptorchidism; Diagnosis; Intestinal obstruction; Treatment.

Figure 1

Abdominal radiography. The dilated intestine with air-fluid levels was prominent in the right middle abdomen.

Figure 2

Abdominal computed tomography scans. Dilated small intestinal loops containing air-fluid levels were clustered in the right middle abdomen and surrounded by a sac-like membrane.

Figure 3

Intraoperative findings. Dilated small intestine was surrounded by a capsular structure in the right middle abdomen, which had a regular surface composed of natural fibrous membranes.

Figure 4

Pathologic examination (HE × 200). The testis with interstitial fibrosis had no spermatogonium, primary spermatocyte, secondary spermatocyte, spermatid, or spermatozoon in the seminiferous tubules.