A case of abdominal cocoon

Abstract

Abdominal cocoon is a rare disease of the peritoneum and almost invariably presents as an acute or subacute intestinal obstruction with or without a mass. The etiology of this disease is largely unknown and abdominal cocoon of unknown etiology has been limited to the tropical and subtropical zones and primarily affects young adolescent females. In the temperate zone, only one case has been reported from the United Kingdom, but the patient was also born in Pakistan. No case of abdominal cocoon purely developed in the temperate zone has been reported. Recently, we experienced a case of abdominal cocoon in a 34-year-old female patient(Korean) who had never been abroad. The diagnosis was made postoperatively by reviewing the literature. We herein report this rare condition developed in an unusual geographical location with a brief review of the literature.

Idiopathic sclerosing encapsulating peritonitis (or abdominal cocoon): A report of 5 cases

“…The fibrocollagenic cocoon can extend to involve other organs like the large intestine, liver and stomach. Clinically, it presents with recurrent episodes of acute, subacute or chronic small bowel obstruction, weight loss, nausea and anorexia, and at times with a palpable abdominal mass, but some patients may be asymptomatic [12] . SEP can be classified as idiopathic or secondary.…”

“…These include retrograde menstruation with a superimposed viral infection [1] , retrograde peritonitis and cell-mediated immunological tissue damage incited by gynecological infection [11] . However, since this condition has also been seen to affect males, premenopausal females and children, there seems to be little support for these theories [2,12,13] . Further hypotheses are therefore needed to explain the cause of idiopathic SEP.…”

Abdominal Cocoon Syndrome

“…Patients usually complain of recurrent attacks of intestinal obstruction. An accurate diagnosis is difficult to make preoperatively [5] because findings on biochemical investigations are usually normal, and imaging findings are nonspecific [7], although plain abdominal X-ray film may show air-fluid levels [8]. In the rare reports of the CT appearance of abdominal cocoon, adherent small bowel loops encased within a thick enhancing peritoneal membrane were visualized [2,7].Other CT features of abdominal cocoon include signs of obstruction, agglutination and the fixation of intestinal loops, mural thickening, ascites and localized fluid collections, peritoneal thickening and enhancement, peritoneal or mural calcifications and reactive adenopathy [10].…”

“…Treatment, as in the present case, consists of excision of the accessory peritoneal sac with lysis of the interloop adhesions. Bowel resection is unnecessary [1,5] unless a nonviable segment is found [7].…”

“…The ideal treatment is operative, with dissection of the membrane from the intestine and separation of adherent loops of the small bowel until they are laid free and return to their normal configuration. [5] CASE REPORT: A 35-year-old male presented with complains of multiple episodes of vomiting, constipation, and abdominal discomfort since twenty days. He suffered similar complaints about a month previously for which he underwent a diagnostic laparoscopy at a small nursing home, which revealed cocooning of small bowel loops.…”