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Abdominal cocoon due to primary peritonitis: barium meal is valuable in diagnosis

G Suryanarayana Raju1

  • 1Department of Surgical Oncology, Nizam's Institute of Medical Sciences, Hyderabad.

Tropical Gastroenterology : Official Journal of the Digestive Diseases Foundation
|October 9, 2004
PubMed

Insights

Abdominal cocoon is a rare cause of bowel obstruction where the small intestine is encased in a membrane. Surgical excision of this membrane can effectively relieve the obstruction, as demonstrated in this case report.

Area of Science:

  • Gastroenterology
  • Surgical Pathology

Background:

  • Abdominal cocoon is an exceedingly rare condition characterized by the small bowel being encased in a fibrous membrane, often mimicking peritoneal fibrosis.
  • This condition has been documented in only 16 case reports globally, highlighting its rarity.

Observation:

  • A 15-year-old female presented with recurrent abdominal pain attributed to distal small bowel obstruction.
  • Radiographic imaging, including X-ray and contrast studies, revealed signs consistent with small intestinal obstruction, including air-fluid levels, dilated proximal small intestine, and narrowing of the distal ileum with preserved mucosal patterns.

Findings:

  • Laparotomy confirmed the presence of a membrane encasing and coiling the small intestine.
  • Excision of this membrane successfully released the intestinal obstruction.

Implications:

  • This case underscores the importance of considering abdominal cocoon in the differential diagnosis of small bowel obstruction, particularly in younger patients.
  • Successful surgical management through membrane excision offers a viable treatment option for this rare condition.

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