Abdominal cocoon: precipitated by laparoscopic gas insufflation

Area of Science:

• Gastroenterology
• Surgical Pathology
• Abdominal Imaging

Background:

• Abdominal cocoon is a rare condition characterized by a fibrous cocoon encasing the small bowel.
• It can lead to intestinal obstruction and is often diagnosed intraoperatively.
• The exact etiology remains unclear, but associations with tuberculosis and foreign body reactions have been suggested.

Purpose of the Study:

• To report a unique case of abdominal cocoon diagnosed incidentally during umbilical hernia repair.
• To discuss the diagnostic challenges and management decisions in such cases.
• To explore the potential role of laparoscopic insufflation as a precipitating factor.

Main Methods:

• Case presentation of a young male with umbilical hernia.
• Intraoperative findings during laparoscopic intraperitoneal onlay mesh (IPOM) repair.
• Subsequent open repair and long-term follow-up.
• Review of literature on abdominal cocoon and sclerosing peritonitis.

Main Results:

• An asymptomatic fibrous film over the small bowel was unexpectedly found during laparoscopic umbilical hernia repair.
• Laparoscopic IPOM was abandoned due to the uncertain nature of the finding.
• The patient later developed intestinal obstruction and was diagnosed with a classic abdominal cocoon.
• The condition evolved from an asymptomatic phase to symptomatic encapsulating sclerosing peritonitis.

Conclusions:

• Abdominal cocoon can present insidiously and may be incidentally discovered during unrelated abdominal surgeries.
• Abandoning mesh placement in suspected cases is a prudent approach.
• Laparoscopic insufflation may be a potential precipitating factor in the development of abdominal cocoon.
• Early recognition and appropriate management are crucial for favorable outcomes.