Idiopathic cocoon abdomen with congenital colon malrotation: a case report and review of the literature

Abstract

Background: Cocoon abdomen is a relatively rare abdominal disease characterized by the total or partial encasement of the small intestinal by a dense fibro-collagenous membrane.

Case presentation: We reported an unusual case of idiopathic cocoon abdomen with congenital colon malrotation. Laparotomy and sac release were performed on the patient. The patient was no recurrence 6 months after operation. A literature review was also performed.

Conclusion: Preoperative diagnosis of abdominal cocoon is difficult. A careful history, physical examination and appropriate radiology may be helpful in making a definitive diagnosis. If conservative treatment can't relieve symptoms effectively, surgery is currently considered to be important in the management of this disease.

Keywords: Cocoon abdomen; Colon malrotation; Diagnosis; Intestinal obstruction; Treatment.

Fig. 1

Erect abdominal x-ray at admission showing hugely dilated small bowel, with multiple air-fluid levels

Fig. 2

Abdominal CT at admission. a: Gallstones. b: Congenital intestinal malrotation. c: Small intestine obstruction with envelope wrap, fluid density around the liver can be seen, multiple gas in the intestine can be seen, accompanied by gas and liquid level

Fig. 3

Intraoperative findings and Pathologic examination (HE × 100). a: A thick white membrane was found encasing the entire dilated small intestine in the abdomen. b: Cyst wall was composed of fibrous connective tissue with a small amount of necrosis and inflammatory cell infiltration