Abdominal cocoon syndrome as rare cause of intestinal obstruction: A case report

Abstract

Introduction: Abdominal cocoon syndrome (ACS) is a rare complication that is hardly diagnosed before surgery. Abnormal membrane in partial or total intestine can make obstruction with generalized abdomen pain.

Case presentation: We present a case of 43-year-old man, who presented to our hospital with generalized abdominal pain, preferably hypogastric. He has recurrent nausea and vomiting with no appetite. Dilated loops were explored between pancreases and stomach that are continued to the ileum. Complete removal of the membrane performed by laparotomy.

Discussion: Idiopathic sclerosing encapsulating peritonitis (SEP), known as cocoon syndrome, is a rare complication with unknown cause and pathology. Obstruction is the chief compliant. Abdominal discomfort, tenderness, nausea, and intestinal distention are also presented. Previous peritoneal dialysis, intra-abdominal inflammation, previous abdominal surgery or trauma, and beta-blocker intake predispose patients to the SEP. The present case has chronic SEP type 2, as the membrane existed in the entire small intestine.

Conclusion: Our case highlights the importance of considering ACS as a differential diagnosis for left upper quadrant abdominal pain in patients with obstructive symptoms, especially by surgeons, because it is difficult to diagnosis before surgery.

Keywords: Abdominal cocoon syndrome; Case report; Obstruction; Surgery.

Fig. 1

Up-right abdominal X-ray revealing air-fluid level.

Fig. 2

CT scan revealing distended small bowel loops.

Fig. 3

Intraoperative findings. A thick membrane covering the small intestine is identified by entering to the abdomen. The abdominal cavity was filled by purulent fluid. A loop completely covered with the membrane. The membrane is completely removed.