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Abdominal Cocoon Syndrome: A Rare Cause of Intestinal Obstruction
Joana Frazão1, Ana Rita Martins1, José Calado1
1General Surgery, Hospital Prof. Doutor Fernando Fonseca, Lisboa, PRT.
Abstract:
Abdominal cocoon syndrome, also known as Sclerosing Encapsulating Peritonitis, is characterized by a fibro-collagenous membrane that involves abdominal viscera and it's a rare cause of intestinal obstruction. We present here two cases. Two male patients, 29 and 75 years old, were admitted to our emergency department with abdominal pain, vomiting, tender and painful abdomen but without changes in intestinal transit or peritoneal reaction. They were treated surgically and diagnosed with abdominal cocoon syndrome. Patients with abdominal cocoon syndrome usually present with recurrent episodes of intestinal obstruction, which result from the compression of the bowel within the constricting cocoon. Most of the time, this clinical picture resolves with conservative measures, delaying the diagnosis. The definitive treatment consists of excision of the membrane with lysis of adhesions, which is usually reserved for more severe cases of obstruction. This is a rare disease, where a high suspicion index is of paramount importance, especially considering that most of the diagnoses are made at the surgery.
Insights
Abdominal cocoon syndrome, a rare cause of intestinal obstruction, involves a membrane constricting bowels. Surgical intervention is key for severe cases, highlighting the need for high clinical suspicion.
Area of Science:
- Gastroenterology
- Abdominal Surgery
Background:
- Abdominal cocoon syndrome (ACS), or Sclerosing Encapsulating Peritonitis, is a rare condition characterized by a fibro-collagenous membrane enveloping abdominal viscera.
- It presents as a rare cause of intestinal obstruction, often leading to delayed diagnosis due to non-specific symptoms.
Observation:
- Two male patients (29 and 75 years old) presented with acute abdominal pain, vomiting, and abdominal tenderness without signs of intestinal transit changes or peritoneal reaction.
- Surgical exploration revealed the characteristic membrane of ACS, leading to a definitive diagnosis.
Findings:
- ACS causes intestinal obstruction through external compression by the encapsulating membrane.
- While conservative measures may temporarily alleviate symptoms, surgical excision of the membrane and lysis of adhesions are definitive treatments for severe obstruction.
Implications:
- A high index of clinical suspicion is crucial for timely diagnosis of ACS, especially when patients present with recurrent or severe intestinal obstruction.
- Early surgical diagnosis and intervention can prevent complications associated with prolonged bowel compression and obstruction.
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