A Case of Abdominal Cocoon Syndrome: A Rare Cause of Small Bowel Obstruction At Aber Hospital in Northern Uganda

  • Abstract
  • Keywords
  • References
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  • Abstract

    Abdominal cocoon syndrome (ACS) is a rare cause of small bowel obstruction characterized by partial or complete encasement of small bowel loops in a thick fibro-collagenous sac. It poses diagnostic difficulties due to the non-specific nature of its presentation and thus in most cases, diagnosed incidentally at laparotomy.

    The researchers present a case of a 27-year old female Ugandan who presented to a rural hospital in Northern Uganda with complaints of central abdominal pain, failure to pass stool and bilious vomiting for three days. She also had feelings of a peri-umbilical mass. She had several episodes of related obstructive symptoms that would be self-limiting for a year. She had unremarkable past surgical, past medical and past gynecological history. Laboratory investigations were unremarkable.

    Preoperative diagnosis of small bowel intussusception was made basing on examination and ultrasonography report and the patient was managed operatively. At laparotomy, almost all the small bowel loops were found encased in a thick, whitish, fibrous membrane. There was also marked inter-loop adhesions. The membranous sac was incised and completely removed using both sharp and blunt dissection. Inter-loop adhesions were released solely by blunt dissection.

    The patient recovered postoperatively and was discharged on the seventh postoperative day.



  • Keywords

    Abdominal Cocoon Syndrome; Small Bowel Obstruction; Laparotomy; Intussusceptions.

  • References

      [1] Deeb, L. S., F. H. Mourad, Y. R. El-Zein and S. M. Uthman (1998). "Abdominal cocoon in a man: preoperative diagnosis and literature review." Journal of clinical gastroenterology 26(2): 148-150.https://doi.org/10.1097/00004836-199803000-00013.

      [2] Gupta, S., A. Gupta, C. Yadav and A. Dwivedi (2013). "Abdominal cocoon: Case report and literature review." Sch J App Med Sci 1: 748-752.

      [3] Hur, J., K. W. Kim, M.-S. Park and J.-S. Yu (2004). "Abdominal cocoon: preoperative diagnostic clues from radiologic imaging with pathologic correlation." American Journal of Roentgenology 182(3): 639-641.https://doi.org/10.2214/ajr.182.3.1820639.

      [4] Ibrahim, N. and M. Oludara (2009). "Abdominal cocoon in an adolescent male patient." Tropical doctor 39(4): 254-256.https://doi.org/10.1258/td.2009.090104.

      [5] Matone, J., F. Herbella and J. C. Del Grande (2006). "Abdominal cocoon syndrome." Clinical Gastroenterology and Hepatology 4(5)https://doi.org/10.1016/j.cgh.2005.12.005.

      [6] Nakamoto, H. (2005). "Encapsulating peritoneal sclerosis--a clinician's approach to diagnosis and medical treatment." Peritoneal Dialysis International 25(Suppl 4): S30-S38.https://doi.org/10.1177/089686080502504S05.

      [7] Navani, S., P. Shah, S. Pandya and N. Doctor (1995). "Abdominal cocoon--the cauliflower sign on barium small bowel series." Indian journal of gastroenterology 14(1): 19-19.

      [8] Serter, A., E. Kocakoç and G. Çipe (2013). "Supposed to be rare cause of intestinal obstruction; abdominal cocoon: report of two cases." Clinical Imaging 37(3): 586-589.https://doi.org/10.1016/j.clinimag.2012.08.010.

      [9] Sharma, D., R. P. Nair, T. Dani and P. Shetty (2013). "Abdominal cocoon—A rare cause of intestinal obstruction." International journal of surgery case reports 4(11): 955-957.https://doi.org/10.1016/j.ijscr.2013.08.004.

      [10] Sieck, J. O., R. Cowgill and W. Larkworthy (1983). "Peritoneal encapsulation and abdominal cocoon: case reports and a review of the literature." Gastroenterology 84(6): 1597-1601.https://doi.org/10.1016/0016-5085(83)90387-6.

      [11] Singh, B. and S. Gupta (2013). "Abdominal cocoon: a case series." International Journal of Surgery 11(4): 325-328.https://doi.org/10.1016/j.ijsu.2013.02.011.

      [12] Solak, A. and İ. Solak (2012). "Abdominal cocoon syndrome: preoperative diagnostic criteria, good linical outcome with medical treatment and review of the literature." The Turkish journal of gastroenterology 23(6): 776-779.https://doi.org/10.4318/tjg.2012.0500.

      [13] Suh, W. N., S. K. Lee, H. Chang, H. J. Hwang, W. J. Hyung, Y. N. Park and T. I. Kim (2007). "Sclerosing encapsulating peritonitis (abdominal cocoon) after abdominal hysterectomy." The Korean journal of internal medicine 22(2): 125.https://doi.org/10.3904/kjim.2007.22.2.125.

      [14] Tannoury, J. N. and B. N. Abboud (2012). "Idiopathic sclerosing encapsulating peritonitis: abdominal cocoon." World journal of gastroenterology 18(17): 1999.https://doi.org/10.3748/wjg.v18.i17.1999.

      [15] Taylor, M., M. G. Clarke, J. Jarvis and M. Booth (2012). "A mystery wrapped in an enigma: The abdominal cocoon syndrome." NZ Med J125: 77-80.

      [16] Vagholkar, K. and K. Doctor-Ganju (2018). "Abdominal cocoon: a surgical challenge." International Surgery Journal 5(12): 4090-4094.https://doi.org/10.18203/2349-2902.isj20184713.

      [17] Wig, J. and S. Gupta (1998). "Computed tomography in abdominal cocoon." Journal of clinical gastroenterology 27(3): 259-260.https://doi.org/10.1097/00004836-199810000-00018.

      [18] Xu, P., L.-H. Chen and Y.-M. Li (2007). "Idiopathic sclerosing encapsulating peritonitis (or abdominal cocoon): a report of 5 cases." World journal gastroenterology 13(26): 3649.https://doi.org/10.3748/wjg.v13.i26.3649.

      [19] Yavuz, R., S. Akbulut, M. Babur and F. Demircan (2015). "Intestinal obstruction due to idiopathic sclerosing encapsulating peritonitis: a case report." Iranian Red Crescent Medical Journal 17(5).https://doi.org/10.5812/ircmj.17(5)2015.21934.




Article ID: 31508
DOI: 10.14419/ijm.v9i1.31508

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