Introduction: Idiopathic localized dilation of the ileum (ILDI) is rare in adults, debuting with nonspecific symptomatology. Case report: a 36-year-old male patient with no past surgical history with intense abdominal pain and acute abdomen upon physical examination and CT imaging evidence of intestinal occlusion. Initial laparoscopic approach, a 30 cm terminal ileum mass with multiple inflammatory mesenteric nodes was found and resected. Post-surgically, further laboratory evaluations failed to justify any other diagnosis rather than ILDI, excluding histopathologic and laboratory compatible with abdominal cocoon syndrome. The patient was discharged without complications and no recurrence of ILDI. Conclusions: Idiopathic localized dilation of the ileum is a rare pathology specially on adults, in children is often associated to other mid-gut congenital anomalies, gastrointestinal blood loss, with or without chronic anemia, and small-bowel obstruction, ILDI should be considered as a exclusion differential diagnose of unrelated intestinal obstruction.
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