Significance of Bottle Gourd sign on computed tomography in patients with abdominal cocoon: a case series

Abstract

Abdominal cocoon is an uncommon entity manifesting as abdominal pain, lump and features of intestinal obstruction. The diagnosis is established by demonstrating a membranous sac covering the small bowel loops which can be seen at the time of surgery or demonstrated by imaging studies like computed tomography (CT) or magnetic resonance imaging. CT has been reported to be of utility in making a preoperative diagnosis. The features may include clumped bowel loops, loculated fluid, cauliflower sign or concertina arrangement of bowel loops. We report on three cases of abdominal cocoon who presented with intestinal obstruction due to three varied etiologies (idiopathic, tuberculosis, malignancy). We also describe a radiological sign, the bottle gourd sign, in these three cases. The sign possibly suggests jejunal obstruction due to formation of abdominal cocoon.

Hernioscopy Revealing Rare Abdominal Cocoon Syndrome in an Elderly Patient: A Novel Technique for Abdominal Pathology

“…Therefore, this was a typical case of idiopathic AC. With the popularization of laparoscopic techniques and advances in CT, an increasing number of AC cases are being diagnosed [ 11 ]. CT has been reported to be a valuable tool for making a definite diagnosis before surgery [ 14 , 17 , 18 ].…”

“…With the popularization of laparoscopic techniques and advances in CT, an increasing number of AC cases are being diagnosed [ 11 ]. CT has been reported to be a valuable tool for making a definite diagnosis before surgery [ 14 , 17 , 18 ]. AC can be categorized into 3 types: type I involves part of the small bowel, type II involves the entire small bowel, and type III involves the small bowel along with the large bowel and other adjacent viscera [ 17 ].…”

“…CT has been reported to be a valuable tool for making a definite diagnosis before surgery [ 14 , 17 , 18 ]. AC can be categorized into 3 types: type I involves part of the small bowel, type II involves the entire small bowel, and type III involves the small bowel along with the large bowel and other adjacent viscera [ 17 ]. The radiographic findings of AC patients’ bowel mainly include clumped loops, inter-bowel fluid, bowel wall thickening/enhancement, and so on [ 18 ].…”

“…The radiographic findings of AC patients’ bowel mainly include clumped loops, inter-bowel fluid, bowel wall thickening/enhancement, and so on [ 18 ]. However, not all of these manifestations are present in a single patient [ 17 – 19 ]. In this case, bowel wall thickening or enhancement was not confirmed on CT.…”

“…To date, several reports have revealed the clinical features, etiopathogenesis, and characteristics of pathology of AC since 1978 [ 7 – 10 ]. However, its etiology and pathogenesis remain unclear [ 8 ], and preoperative diagnosis remains difficult [ 9 , 11 ]. Therefore, most cases are accidentally discovered intraoperatively.…”