Abdominal cocoon secondary to tuberculosis

Abstract

Abdominal cocoon or sclerosing encapsulating peritonitis is a rare cause of intestinal obstruction that has been described mostly in young adolescent girls. Thick fibrotic peritoneum encasing the small bowel in a small volume is a pathognomonic feature. This condition presents many difficulties in preoperative diagnosis. Early diagnosis can result in proper management, and may prevent the need for bowel resection. The author reports a case of a male patient with intermittent subacute intestinal obstruction and an abdominal cocoon encasing the small bowel secondary to abdominal tuberculosis, which was suspected preoperatively by radiology. To the best of our knowledge, this case represents one of the very few male patients with this disease entity reported in medical literature.

Abdominal cocoon in a young man

“…In such 'primary' cases, it has been hypothesized that the encasing membrane or cocoon arises either as a result of subclinical peritoneal infl ammation, immunological reaction to viral infections, or infections of the genital organs, or even, retrograde menstruation; however, as of now, there is no conclusive evidence to favor any of these theories, especially since more and more reports are coming out of the disease in older patients and even in males. [1][2][3][4][5] Our patient, too, adds to the growing list of idiopathic abdominal cocoon being seen in male patients, adding further to the questionability of the above mentioned hypotheses. We feel that the disease arises as a peritoneal reaction secondary to an exaggerated immune response to some yet, unidentifi ed stimulus.…”

“…Simply cutting through this membrane and releasing the contained bowel loops is curative in the large majority of patients with a primary cocoon, but at times, [2,4] extensive adhesiolysis and resection of the bowel may also be needed. [1] Biopsy from the cocoon wall usually shows dense fibrocollagenic tissue along with a mixed inflammatory infiltrate, but is important in ruling out other causes such as tuberculosis. [1,4] Although we have encountered tuberculosis as a cause of abdominal cocoon previously, [4] this patient did not have any evidence of tuberculosis, thus clinching the diagnosis of an idiopathic abdominal cocoon.…”

“…[1] Biopsy from the cocoon wall usually shows dense fibrocollagenic tissue along with a mixed inflammatory infiltrate, but is important in ruling out other causes such as tuberculosis. [1,4] Although we have encountered tuberculosis as a cause of abdominal cocoon previously, [4] this patient did not have any evidence of tuberculosis, thus clinching the diagnosis of an idiopathic abdominal cocoon. …”

“…Commonly, adhesions and bands are implicated in developed countries, whereas obstruction of inguinal hernia and tuberculosis of the gastrointestinal tract are the common offenders in the developing countries. [1] The 'cocoon' remains an obscure and relatively uncommon cause of intestinal obstruction that is seen more commonly in females, wherein the intestine is encased in a thin, semitransparent membrane that causes obstruction by mechanical compression and kinking of the intestine loops contained within. [1][2][3][4][5] We report the case of recurrent intestinal obstruction in a young male patient that was secondary to an abdominal cocoon and was managed successfully in our hospital.…”

Abdominal Cocoon – A Rare Complication of Abdominal Tuberculosis

“…Abdominal cocoon is not only a rare complication of abdominal tuberculosis but also a rare cause of intestinal obstruction [1]. As this condition is characterised by thickening and fibrosis of peritoneum with subsequent wrapping of the variable length of small and sometimes, large bowel in a stack or concertina pattern, it is also known as peritonitis chronic fibrosa incapsulata or sclerosing encapsulating peritonitis [2].…”