Abdominal cocoon - A rare etiology of intestinal obstruction

Jagdale, Amol; Prasla, Shopnil; Mittal, Shruti

doi:10.4103/2249-4863.222040

Cited by 12 publications

(6 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 1868, Cleland documented the presence of an additional peritoneal membrane, believed to originate from the yolk sac peritoneum. He coined the term "peritoneal encapsulation" and classified it as a congenital condition, as there was no discernible evidence of preceding inflammatory processes [ 1 , 2 ]. This membrane, characterized by its similarity in structure to the peritoneum, encases the small intestine.…”

Section: Discussionmentioning

confidence: 99%

“…The most common clinical presentation associated with this syndrome is intestinal obstruction [ 1 , 2 ]. Clinical signs encompass abdominal distension, abdominal discomfort or pain, and absolute constipation, as well as nausea and vomiting.…”

Section: Discussionmentioning

confidence: 99%

“…Historical records of this syndrome can be traced back to the 1860s [ 1 ], with documented cases exhibiting a broad spectrum of clinical presentations. These range from mild abdominal discomfort and distension to severe symptoms such as absolute constipation and acute abdomen [ 1 , 2 ], necessitating urgent surgical intervention due to complications like perforation or ischemia. Despite its long-standing recognition, the precise mechanisms underlying its development continue to elude us, leaving many questions unanswered [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Small Bowel Obstruction Due to Abdominal Cocoon Syndrome in Post-COVID-19 Patients

Aboelnaga,

Elkadi,

Abdelhady

et al. 2024

Cureus

View full text Add to dashboard Cite

Background: Abdominal cocoon syndrome, also recognized as encapsulating peritoneal sclerosis, is an exceedingly rare medical condition characterized by an anomalous membranous envelopment of the small bowel. Despite its clinical rarity, the precise etiology and pathogenic mechanisms of this syndrome remain elusive. Methods: This comprehensive discussion presents a case series encompassing six patients who sought medical attention in the Emergency Room, all sharing a common presentation: severe abdominal distension and persistent constipation. Intriguingly, these symptoms manifested following recent severe coronavirus disease 2019 (COVID-19) infections. Remarkably, none of these patients had significant medical histories or had undergone prior surgical interventions, rendering their cases even more enigmatic. Results: The defining feature across all six cases emerged during exploratory laparotomy, where a consistent finding stunned the surgical team: the discovery of a thick, fibrous membrane enveloping segments of the small bowel. The surgical procedure entailed meticulous dissection and subsequent removal of this membrane, with tissue samples dispatched for histopathological evaluation. This diagnostic approach conclusively confirmed the presence of abdominal cocoon syndrome in each of these patients. Discussion: The focal point of our discussion revolves around a potential connection between recent severe COVID-19 infection, intensive care unit admissions, and the subsequent development of abdominal cocoon syndrome. This intriguing association compels further inquiry to unveil the precise pathogenesis of this syndrome, particularly within the context of COVID-19. Given the diagnostic complexities associated with abdominal cocoon syndrome, this report underscores the indispensability of maintaining a heightened clinical suspicion and the significance of rigorous intraoperative assessments to ensure timely diagnosis and effective management. Conclusion: Abdominal cocoon syndrome represents a rare and enigmatic medical condition characterized by its uncertain etiology. Our case series tantalizingly suggests a link between recent severe COVID-19 infection and the development of this syndrome. Nevertheless, comprehensive research endeavors are warranted to unravel the intricate mechanisms that underlie this intriguing association. In light of the diagnostic challenges associated with abdominal cocoon syndrome, this report underscores the pivotal role of exploratory surgery, in the absence of definitive radiological imaging, as the cornerstone for both diagnosis and therapeutic intervention. The pursuit of further investigations into the intricate relationship between COVID-19 and abdominal cocoon syndrome may ultimately yield the critical insights needed to demystify this complex medical enigma.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Small Bowel Obstruction Due to Abdominal Cocoon Syndrome in Post-COVID-19 Patients

Aboelnaga,

Elkadi,

Abdelhady

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

“…Histologically, the sac of PE is the crystalloid peritoneum, which is normal, has no fibrosis and no adhesion with the intestine. However, AC often presents with omental dysplasia or absence, and the sac is formed of thickened collagen and fibrous tissue, which may be accompanied by nonspecific chronic inflammation (26,32,33). In addition, AC also needs to be identified with tuberculosis, peritoneal mesothelioma and peritoneal pseudomyxoma (27,32,33).…”

Section: Discussionmentioning

confidence: 99%

Imaging and treatment of idiopathic abdominal cocoon in 9 patients

Rui

Yang

et al. 2019

Exp Ther Med

View full text Add to dashboard Cite

The aim of the current study was to investigate the imaging features of abdominal cocoon (AC), the methods of diagnosis and treatment of AC and improve understanding of AC. To do this, the current study retrospectively analyzed the clinical data and imaging findings of nine patients with AC. The clinical manifestations included intestinal obstruction in six out of the nine cases of AC, which included two cases of bowel strangulation and five cases of soft masses in the abdomen. Imaging features of AC included the following: i) Bowel loops were usually present in a fixed cluster; ii) bowel loops were encapsulated partially or totally by a thickening fibrous membrane-like ‘cocoon’; iii) bowel wall thickened in the ‘cocoon’, and the bowel loops and sac adhered; iv) loculated ascites in the ‘cocoon’; v) abnormal clustering of the mesenteric vasculature, hypoplasia of the omentum majus was present or absent; and vi) Ileus occurred in some cases. The features of a plain abdominal X-ray, a gastrointestinal barium meal series and ultrasonography lacked specificity. The results of CT in eight out of nine cases of AC were consistent with the surgical findings. Surgery was the first choice of therapy. All cases were treated surgically, showing that the bowel loops were encapsulated partially or totally by a thickened fibrous membrane. All cases received operations including partial or total excision of the membrane and enterolysis. In conclusion, CT may be highly valuable in the preoperative diagnosis of AC.

show abstract

“…[ 11 ] These hypotheses involve retrograde menstruation with a superimposed viral infection, retrograde peritonitis via the fallopian tubes, and cell-mediated immunological tissue damage secondary to gynecological infection. [ 12 ] Therefore, population district and gender may seem to be an important etiological agent of AC. In recent years, some new cases reported seem to be in contradiction with the previous theories.…”

Section: Discussionmentioning

confidence: 99%

Abdominal cocoon with early postoperative small bowel obstruction

et al. 2018

View full text Add to dashboard Cite

Rationale:Abdominal cocoon is a condition in which intestinal obstruction results from the encasement of part or whole of the small bowel by a thick fibrous membrane, giving the appearance of a cocoon. The preoperative diagnosis is difficult to be made and the treatment is still controversial.Patient concerns:Here we describe the case of a 62-year-old male presented with a 24-h history of continual colicky abdominal pain, which was accompanied with nausea and vomiting.Diagnosis:Accurate diagnosis of abdominal cocoon was made intraoperatively.Interventions:Membrane excision and adhesiolysis were performed and the patient experienced early postoperative small bowel obstruction. Nasointestinal obstruction tube was then installed and bowel function was gradually recovered by the 20th postoperative day.Outcomes:The patient recovered well and was discharged from the hospital on the 30th postoperative dayLessons:Abdominal cocoon can occur at any age. The possibility of abdominal cocoon should also be considered in infertile patients. Imaging studies may be helpful to make the correct diagnosis, and surgery should be performed for patients with recurrent acute or chronic intestinal obstruction.

show abstract

Abdominal cocoon - A rare etiology of intestinal obstruction

Cited by 12 publications

References 12 publications

Small Bowel Obstruction Due to Abdominal Cocoon Syndrome in Post-COVID-19 Patients

Small Bowel Obstruction Due to Abdominal Cocoon Syndrome in Post-COVID-19 Patients

Imaging and treatment of idiopathic abdominal cocoon in 9 patients

Abdominal cocoon with early postoperative small bowel obstruction

Contact Info

Product

Resources

About