Abdominal cocoon: an unexpected cause of ascites in a healthy patient

Abstract

Abdominal cocoon is the idiopathic fibrotic encasement of abdominal organs. It classically presents as small bowel obstruction in young women. In this case report, we present a rare example of a patient presenting solely with massive ascites of presumed gynecologic origin, who upon surgical exploration was found to have abdominal cocoon. We discuss the patient’s unique disease presentation, unrevealing work-up and the treatment strategy pursued, and provide a review of the literature.

Abdominal cocoon syndrome, a diagnostic challenge affecting the treatment. A rare case report from Somalia

“…Conservative treatment consists of observation alone or insertion of a long nasointestinal decompression tube with medical treatment. Some reports have demonstrated successful trials by using steroids, colchicine, tamoxifen or azathioprine [ 7 ].…”

Idiopathic Sclerosing Encapsulating Peritonitis in a Patient with Atypical Symptoms and Imaging Findings

“…While classically reported to present with signs and symptoms of bowel obstruction, a recent report showed a diagnosis of SEP in an otherwise healthy female also presenting with massive abdominal distention with ascites [ 13 ]. This presentation is similar to our case.…”

“…It is agreed upon that operative resection of the fibrous membrane is the definitive treatment. Operative management is preferred in patients with acute small bowel obstructions or if other organs are involved [ 13 ]. However, our patient was assumed to present in the earlier stages as he did not have an obstruction.…”

“…However, our patient was assumed to present in the earlier stages as he did not have an obstruction. Conservative management is an option for asymptomatic patients without obstruction, and steroids, tamoxifen, colchicine, azathioprine, and mycophenolate mofetil have been utilized [ 12 , 13 ]. Tamoxifen specifically has been utilized in multiple other diseases of excessive fibrosis, such as retroperitoneal fibrosis, fibrosing mediastinitis, idiopathic sclerosing cervicitis, and desmoid tumors [ 14 ].…”

Case report of a rare cause of intestinal obstruction: Abdominal cocoon syndrome

“…In our case, the preoperative pre-diagnosis was made with the help of an abdominal X-ray and especially CT. Surgery is considered the gold standard treatment for ACS [13]. Surgery is often long and difficult, and recurrence of intestinal obstruction due to intestinal adhesion may occur after surgery.…”