Abdominal cocoon

  • SK Basu Sr.Consultant General & Lap Surg, Apollo Hospitals Dhaka
  • R Hassan Reg surgery, Apollo Hospitals Dhaka
  • CA Zaman Reg. Surgery, Apollo Hospitals Dhaka
  • KMS Islam Reg. Plastic Surgery,Apollo Hospitals Dhaka
  • JMHQ Alam Reg surgery, Apollo Hospitals Dhaka
  • M Jamil RMO - General Surgery, Apollo Hospitals Dhaka
  • N Ahmed RMO - General Surgery, Apollo Hospitals Dhaka
  • D Hossain Reg. General Surgery, Apollo Hospitals Dhaka
Keywords: Fibrous membrane, peritonitis, sclerosing peritonitis, abdominal cocoon


Background The abdominal cocoon syndrome was first described as a rare condition where part of or the whole small bowel is encased within a fibrous membrane. Idiopathic sclerosing encapsulating peritonitis (or abdominal cocoon) is a rare cause of small bowel obstruction, especially in adult population. Diagnosis is usually incidental at laparotomy. But preoperative diagnosis can be made.

Case presentation This report is of a 27-year-old Bangladeshi male who presented with increasing abdominal pain and features of subacute intestinal obstruction. He had a history appendicectomy 2 months back through grid iron incision in a peripheral hospital. Pre-operative work-up did not reveal a sac like structure encasing small intestinal loops. At computed tomography of the abdomen and pelvis, a huge cystic structure was seen encasing loops of small bowel. At laparotomy, a fibrous capsule was revealed, in which small bowel loops were encased, with the presence of interloop adhesions. A diagnosis of primary abdominal cocoon was established and extensive adhesiolysis was performed. The patient had an uneventful recovery and follow-up. No evidence of Kochs noted in the abdomen or on histopathology of tissue sent for examination.

Conclusion Abdominal cocoon is a rare cause of small bowel obstruction, but should be suspected especially in cases with attacks of non strangulating obstruction in the same individual. A high index of clinical suspicion may be generated by the recurrent character of small bowel obstruction. Clinicians must rigorously pursue a preoperative diagnosis. The overall prognosis is satisfactory.

DOI: http://dx.doi.org/10.3329/pulse.v5i2.20269

Pulse Vol.5 July 2011 p.61-64


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How to Cite
Basu, S., Hassan, R., Zaman, C., Islam, K., Alam, J., Jamil, M., Ahmed, N., & Hossain, D. (2014). Abdominal cocoon. Pulse, 5(2), 61-64. https://doi.org/10.3329/pulse.v5i2.20269
Case Reports