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Case Reports
. 2019 Apr 3:2019:3276919.
doi: 10.1155/2019/3276919. eCollection 2019.

Abdominal Cocoon Syndrome: Two Cases of an Anatomical Abnormality

Apostolos Sovatzidis  1 , Eirini Nikolaidou  1 , Anastasios Katsourakis  1 , Iosif Chatzis  1 , George Noussios  2
Affiliations
Case Reports

Abdominal Cocoon Syndrome: Two Cases of an Anatomical Abnormality

Apostolos Sovatzidis et al. Case Rep Surg. .

Abstract

Introduction: Idiopathic sclerosing encapsulating peritonitis or abdominal cocoon syndrome (ACS) is a rare anatomical deformity characterized by the partial or complete encasement of the small intestine with fibrotic peritoneum. 193 cases have been described worldwide. The aim of this study is to present two cases of ACS successfully treated at the Surgical Clinic of the Agios Dimitrios General Hospital in Thessaloniki, Greece.

Presentation of cases: Two men (55 and 54 years old) presented to the emergency department complaining of abdominal pain, distension, constipation, nausea, and vomiting. Neither of these patients had any previous operations. The computed tomography scan of the first patient showed considerable distension of the small bowel, suggestive of internal herniation. The second case showed distention of the jejunum with no obvious cause. Both patients underwent emergency surgery. Intraoperatively, it was found that a fibrous membrane had completely covered the small intestine of the first patient and the jejunum and part of the large intestine of the second patient. Adhesiolysis and partial excision of the membrane were performed in both cases.

Discussion: ACS is a rare cause of small bowel obstruction. Although conservative management with immunosuppressants and steroids has been described, surgical treatment is the gold standard.

Conclusion: Preoperative clinical suspicion of this disease can help determine the diagnosis and protect surgeons from intraoperative "surprises".

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Figures

Figure 1
Figure 1
Computed tomography image from case 1. A postoperative second look at the image revealed the presence of a thick fibrotic membrane with a cocoon-like shape that was initially described as internal herniation (arrow).
Figure 2
Figure 2
Intraoperative findings of case 1. The membrane covering the dilated loops of the small intestine (arrow).
Figure 3
Figure 3
Intraoperative findings of case 1. Intestinal loops released from the cocoon-like membrane (arrow).
Figure 4
Figure 4
Computed tomography findings of case 2. Dilated small bowel loops, wall thickness, amorphous calcifications, and signs of obstruction could be seen (arrows).
Figure 5
Figure 5
Intraoperative findings of case 2. Excision of the peritoneal membrane that covered the dilated small and large bowel (arrow).
See this image and copyright information in PMC

References

    1. Foo K. T., Ng K. C., Rauff A., Foong W. C., Sinniah R. Unusual small intestinal obstruction in adolescent girls: the abdominal cocoon. British Journal of Surgery. 1978;65(6):427–430. doi: 10.1002/bjs.1800650617. - DOI - PubMed
    1. Sharma D., Nair R. P., Dani T., Shetty P. Abdominal cocoon—a rare cause of intestinal obstruction. International Journal of Surgery Case Reports. 2013;4(11):955–957. doi: 10.1016/j.ijscr.2013.08.004. - DOI - PMC - PubMed
    1. Akbulut S. Accurate definition and management of idiopathic sclerosing encapsulating peritonitis. World Journal of Gastroenterology. 2015;21(2):675–687. doi: 10.3748/wjg.v21.i2.675. - DOI - PMC - PubMed
    1. Browne L. P., Patel J., Guillerman R. P., Hanson I. C., Cass D. L. Abdominal cocoon: a unique presentation in an immunodeficient infant. Pediatric Radiology. 2012;42(2):263–266. doi: 10.1007/s00247-011-2135-y. - DOI - PubMed
    1. Kaur R., Chauhan D., Dalal U., Khurana U. Abdominal cocoon with small bowel obstruction: two case reports. Abdominal Imaging. 2012;37(2):275–278. doi: 10.1007/s00261-011-9754-5. - DOI - PubMed

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