Abdominal cocoon syndrome, a diagnostic challenge affecting the treatment. A rare case report from Somalia

Abstract

Abdominal cocoon syndrome is defined as idiopathic encapsulation of the bowel within a fibrocollagenous membrane and is considered as a rare cause of small bowel obstruction. A 15-year-old female presented complaining of right lower abdominal pain, distension and vomiting for 24 hours with previous similar attacks in the last four years. She had no another significant medical or surgical history. Computed tomography study revealed matted mildly distended bowel loops centrally with a suspicion of acute appendicitis. Next day, abdominal pain was the only clinical finding and acute appendicitis was the primary diagnosis. During surgery, most of the small bowel was found to be encapsulated within a cocoon-like fibrous membrane. The appendix was congested. Appendectomy, full resection of the membrane and dense adhesiolysis were performed. Herein, we will present the first reported case from Somalia and discuss the radiological findings affecting the management for such a rare disease.

Keywords: abdominal cocoon syndrome; computed tomography; intestinal obstruction; sclerosing encapsulated peritonitis.

Figure 1

Intra-operative view: most of the small bowel was encapsulated within thickened white, fibrous cocoon like membrane including the distal half of jejunum, ileum and cecum. The appendix was not included within the membrane and congested (black arrow).

Figure 2

Intra-operative view: starting sharp dissection for the membrane and the small bowel dense adhesions.

Figure 3

Intra-operative view: complete membrane resection with full small intestine adhesiolysis.

Figure 4

Retrospective review of ECT (axial section), a membrane encapsulates the small intestine centrally indicates the diagnosis of ACS (black arrows).

Figure 5

Retrospective review of ECT (coronal section), a membrane encapsulates the small intestine centrally indicates the diagnosis of ACS (black arrows).