A rare case of abdominal cocoon

Area of Science:

• Gastroenterology
• Surgical Pathology
• Parasitology

Background:

• Abdominal cocoon is a rare condition characterized by a membrane encasing the small bowel, leading to mechanical obstruction.
• Preoperative diagnosis of abdominal cocoon is notoriously difficult, often leading to incidental findings during laparotomy.
• The exact etiology remains unclear, though chronic irritation and inflammation are implicated.

Observation:

• A 33-year-old male presented with symptoms of small intestinal obstruction.
• CT abdomen revealed signs consistent with obstruction, and intraoperative findings showed a dense membrane encapsulating the small bowel.
• Histological examination confirmed granulomatous peritonitis and the presence of Ascaris Lumbricoides.

Findings:

• The patient's presentation and imaging suggested cocoon syndrome causing bowel obstruction.
• Surgical intervention revealed the characteristic cocoon membrane.
• Histopathology confirmed a parasitic cause (Ascaris Lumbricoides) contributing to granulomatous peritonitis.

Implications:

• This case underscores the diagnostic challenges of abdominal cocoon syndrome.
• It highlights a potential parasitic etiology for abdominal cocoon, specifically Ascaris Lumbricoides.
• Surgical management remains essential, with histopathology crucial for definitive diagnosis and understanding pathogenesis.