The Abdominal Cocoon: A Rare Cause of Intestinal Obstruction in Two Patients

Abstract

The abdominal cocoon is a rare disease that is characterized by total or partial encasement of the small bowel by a thick and fibrotic membrane. After an increased number of case reports, the characteristic age group and sex distribution of abdominal cocoon have changed. Although the etiology is unknown, congenital malformation is implicated as the causative factor in the two patients in this report. Although preoperative diagnosis is a matter of challenge and usually made at laparotomy, our experience suggests that computed tomographic evidence of clustered small bowel loops encased by a thin membrane-like sac is a characteristic preoperative finding in patients with abdominal cocoon. Surgical removal of the membrane and adhesions is the most appropriate choice of therapy.

Recognizing a Hidden Cause of Bowel Obstruction: The Abdominal Cocoon

“…Although the exact pathogenesis of this syndrome is still unclear, some have proposed peritoneal dialysis as well as tuberculosis infection of the female genital tract, meconium peritonitis, sarcoidosis, and orthotopic liver transplantation as possible etiologies. 1 This case highlights the intraoperative diagnosis of abdominal cocoon in an 86-year-old man presenting with small bowel obstruction.…”

“…In fact, reports of emerging cases suggest that it occurs more frequently in middle-aged men in contrast to past beliefs. 1 In conclusion, the abdominal cocoon syndrome should be considered in the differential diagnosis of…”

“…Abdominal cocoon syndrome, also known as idiopathic sclerosing encapsulating peritonitis, is a rare cause of small bowel obstruction involving a thick fibrotic layer wrapped around the small bowel. It was first described in 1978, 1 with an overwhelming majority of the cases occurring in adolescent girls in tropical regions. Although the exact pathogenesis of this syndrome is still unclear, some have proposed peritoneal dialysis as well as tuberculosis infection of the female genital tract, meconium peritonitis, sarcoidosis, and orthotopic liver transplantation as possible etiologies.…”

“…First described in 1978, abdominal cocoon syndrome has been described in little over 300 people worldwide, predominantly young adolescent females living in tropical and subtropical zones. 1 A review of literature suggested retrograde menstruation as the cause of infertility and cocoon formation. 1 Since then, several hypotheses have been proposed to explain this rare cause of small bowel obstruction.…”

“…1 A review of literature suggested retrograde menstruation as the cause of infertility and cocoon formation. 1 Since then, several hypotheses have been proposed to explain this rare cause of small bowel obstruction. In congenital cases, the cocoon is an accessory peritoneal sheath formed by the yolk sac lining.…”