Abdominal cocoon in a young man

Idiopathic encapsulating peritoneal sclerosis presenting with abdominal mass

A man in his late 30s presented with a history of recurrent colicky abdominal pain, bilious vomiting and intermittent mass formation in the lower abdomen. The mass was mobile, non-tender and fluctuant, and appeared in the right iliac fossa during episodes of pain and disappeared once the pain subsided. Contrast-enhanced CT (CECT) scan revealed a thick membrane-like structure covering the clumped small bowel loops, suggestive of an abdominal cocoon. A midline laparotomy was carried out with extensive adhesiolysis, and a membrane incision was performed. The final histopathological diagnosis was primary encapsulating peritoneal sclerosis. Encapsulating peritoneal sclerosis of idiopathic origin is rare and typically presents as an acute or subacute intestinal obstruction. A CECT scan is the diagnostic modality of choice, with a thick peritoneal membrane covering the small bowel loops being the hallmark sign. Surgical intervention is the preferred treatment for idiopathic cases, while medical management may address secondary causes.

Idiopathic cocoon abdomen with congenital colon malrotation: a case report and review of the literature

BACKGROUND

Cocoon abdomen is a relatively rare abdominal disease characterized by the total or partial encasement of the small intestinal by a dense fibro-collagenous membrane.

CASE PRESENTATION

We reported an unusual case of idiopathic cocoon abdomen with congenital colon malrotation. Laparotomy and sac release were performed on the patient. The patient was no recurrence 6 months after operation. A literature review was also performed.

CONCLUSION

Preoperative diagnosis of abdominal cocoon is difficult. A careful history, physical examination and appropriate radiology may be helpful in making a definitive diagnosis. If conservative treatment can't relieve symptoms effectively, surgery is currently considered to be important in the management of this disease.

Abdominal cocoon: preoperative diagnosis on CT

A 23-year-old man presented to the emergency department with a history of recurrent episodes of subacute intestinal obstruction. Palpation revealed a firm, non-tender, mobile, non-pulsatile mass of size 8-10 cm with indistinct margins and smooth surface in the hypogastrium. Contrast-enhanced CT scan of the abdomen showed clumping of the small bowel loops within a well-defined membrane-like structure without dilatation or thickening of bowel loops. The patient underwent a laparotomy with incision of the membrane and separation of all the small bowel loops inside the cocoon. Abdominal cocoon is the idiopathic variety of sclerosing encapsulating peritonitis and is an unusual cause of acute or subacute intestinal obstruction. Clinical diagnosis is difficult because of non-specific symptoms. CT has facilitated accurate preoperative diagnosis, long before the patient presents with full-fledged symptoms of acute intestinal obstruction. CT scan plays a significant role in excluding the secondary causes and helps in patient management.