Rare etiology of mechanical intestinal obstruction: Abdominal cocoon syndrome

Abstract

Abdominal cocoon syndrome is a rare cause of intestinal obstruction with unknown etiology. Diagnosis of this syndrome, which can be summarized as the small intestine being surrounded by a fibrous capsule not containing the mesothelium, is difficult in the preoperative period. A 47-year-old male patient was referred to the emergency department with complaints of abdominal pain, nausea, and vomiting for two days. The abdominal computed tomography examination detected dilated small intestinal loops containing air-fluid levels clustered in the left upper quadrant of the abdomen and surrounded by a thick, saclike, contrast-enhanced membrane. During exploratory surgery, a capsular structure was identified in the upper left quadrant with a regular surface that was solid-fibrous in nature. Abdominal cocoon syndrome is a rarely seen condition, for which the preoperative diagnosis is difficult. The combination of physical examination and radiological signs, and the knowledge of “recurrent characteristics of the complaints” that can be learned by a careful history, may be helpful in diagnosis.

Keywords: Intestinal obstruction; Abdominal cocoon syndrome; Preoperatively diagnosis; Adult patient

Core tip: Abdominal “cocoon” is an extremely rare cause of small bowel obstruction. It should be thought of as a rare cause of small bowel obstruction. Its diagnosis is rarely made preoperatively. It has been reported mainly in young adolescent women. But in this adult patient, the small bowel is encased in a fibrous sac called an abdominal cocoon. The clinical manifestations of abdominal “cocoon” are non-specific. The combination of physical examination and radiological signs, and the knowledge of “recurrent characteristics of the complaints” which can be learned by a careful history, may be helpful in diagnosis. Surgery remains the main stay of treatment with satisfactory outcome.