Abdominal Cocoon and Adhesiolysis: A Case Report and a Literature Review

Abdominal cocoon is a rare cause of intestinal obstruction. It is difficult to diagnose in most of the cases preoperatively. Surgical removal of the membrane resulted in complete recovery in the majority of the cases. The exact etiology of abdominal cocoon is still unknown. We reported a male patient who presented with features of intestinal obstruction and has been diagnosed as abdominal cocoon intraoperatively. 1. Introduction Abdominal cocoon is a rare condition that refers to total or partial encapsulation of the small bowel by a fibrocollagenous membrane or cocoon with local inflammatory infiltrate leading to acute or chronic bowel obstruction [1]. The condition has been described with various names including “peritonitis chronica fibrosa incapsulata” by Owtschinnikow in 1907 [2]. Abdominal cocoon is predominantly reported among females from the tropical and subtropical regions. However, adult males were also reported to represent cases of abdominal cocoon [1, 3–5]. Herein, we present a case with this condition that we believe to be the first one reported in Qatar. 2. Case Report A 41-year-old male patient was admitted to the general surgery department of our hospital, complaining of abdominal pain, nausea, and vomiting. He had clinical history of several attacks of abdominal pain over the last seven months. He is a known case of eczema and was on local steroids since four years. The patient had no history of previous abdominal operation. On physical examination, a soft, nontender, and mobile mass was palpated in the right half of the abdomen. No hepatomegaly or splenomegaly was observed. Bowel sounds were a bit hyperactive, and rectal examination was normal. There was no abnormality in the complete blood count and blood chemistry. CT abdomen revealed multiple clumped small bowel loops in the lower abdomen on the right side with no passage of oral contrast. The adherent bowel loops showed wall enhancement with contrast (Figure 1). Figure 1: CT showing membrane enveloping loops of small bowel. The patient underwent emergency explorative laparotomy. The entire small bowel was found to be encased in a cocoon-like fibrous membrane which extended laterally to involve ascending and descending colon (Figure 2). A 2？cm diverticulum was seen in the terminal ileum. Other organs were normal. Lysis of the membrane was carried out, and loops were separated by dissection. The freed small bowel segments were viable, and excision of the diverticulum was done. Figure 2: Intraoperative photograph shows the encapsulated small bowel with a dense fibrous layer.