Difficult to Diagnose the Cause of Intestinal Obstruction due to Abdominal Cocoon Syndrome

Ulusoy, Cemal; Nikolovski, Andrej; Öztürk, Nadi Nazım

doi:10.12890/2021_002588

Cited by 4 publications

(4 citation statements)

References 9 publications

(10 reference statements)

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“…CT scan shows dilatation of the intestines proximal to the constricting band, ascites, and mesenteric thickening. Some cases reported a cauliflower sign on CT suggestive of cocoon syndrome [9]. In our case, there were signs of intestinal occlusion with a double loop sign and infiltrating mesenteric fat that could fit with the cocoon diagnosis.…”

Section: Discussionsupporting

confidence: 59%

“…The prognosis post-operation is usually excellent, as in our case, where the patient had a favorable clinical course after the adhesiolysis, and follow-up assessment after two and four weeks from discharge revealed no recurrence of symptoms and his life was back to normal [6,9].…”

Section: Discussionsupporting

confidence: 52%

“…A patient diagnosed with cocoon syndrome could be asymptomatic and discovered incidentally during laparotomy for any other reason or symptomatic presenting to the emergency department with an acute abdomen and a picture of acute or chronic episodes of small bowel obstruction due to the constricting cocoon band. They experience abdominal pain, nausea, vomiting, and constipation [6,9,10].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Abdominal Cocoon Syndrome in a Liver Transplant Patient: A Case Report and Review of the Literature

Mckey¹,

Charara²,

Sayed³

et al. 2023

Int J Clin Res

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Introduction: Cocoon syndrome is an uncommon cause of intestinal obstruction caused by the formation of a fibrous band around small intestines, thought to be caused by chronic peritoneal inflammation and associated with several conditions such as liver cirrhosis and liver transplantation. Case Report: We present a case of a 72-year-old male patient who had liver transplantation three years ago for liver cirrhosis. He had an acute presentation of intestinal obstruction where a computed tomography (CT) scan showed dilated bowel loops and signs of intestinal ischemia, which warranted surgical laparotomy where the diagnosis of cocoon syndrome (sclerosing encapsulating peritonitis) was made and was then treated by adhesiolysis. No immediate or postoperative complications were documented and his life was back to normal. Conclusion: Therefore, an abdominal cocoon is a challenging diagnosis and should be considered in front of intestinal obstruction, especially in those with risk factors such as liver transplantation.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Abdominal Cocoon Syndrome in a Liver Transplant Patient: A Case Report and Review of the Literature

Mckey¹,

Charara²,

Sayed³

et al. 2023

Int J Clin Res

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“…Primary or idiopathic ACS as a rare disease can easily be overlooked by doctors. To confirm the diagnosis before surgery is extremely difficult, so it is essential to remain a high index of clinical suspicion in differential diagnosis 12 , 13 . The early clinical manifestations are unspecific.…”

Section: Clinical Discussionmentioning

confidence: 99%

Abdominal cocoon syndrome (ACS): a case report of a Chinese male diagnosed idiopathic ACS with inborn short intestine

Li,

Xie

2023

Annals of Medicine &Amp; Surgery

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Introduction and Importance: Abdominal cocoon syndrome (ACS), as a rare cause of mechanical intestinal obstruction, can be divided into primary/idiopathic vs. secondary type. The primary ACS is often asymptomatic and only diagnosed in exploratory laparotomy. The major treatment of surgery can be challenging. Since the gut wall and peritoneum are densely adhered, gut perforation might occur during adhesiolysis. Thus, it is important to have an experienced surgeon to perform the surgery. Case presentation: We present a primary ACS case of a 50-year-old man. The patient demonstrated an unbearable upper abdominal pain upon admission. A CT scan showed a severe bowel obstruction. An exploratory laparotomy was indicated, leading to the diagnosis of ACS, which was considered idiopathic after ruling out secondary factors. An adhesiolysis was performed successfully. Note that the entire intestine measured was only 2.1 meters during the surgery. There was no post-surgical complication. The patient was recovered uneventfully. Clinical Discussion: The etiology of primary ACS is unknown. The incidence is comparatively low and considered equal between men and women. As a rare cause of gut obstruction, the suspicion of the diagnosis should be strengthened. Surgery including adhesiolysis and bowel resection remains the major treatment. If adhesiolysis fails, bowel resection will be inevitable. The knowledge and experience of surgeon will be tested. Conclusion: The etiology of primary ACS should be further explored. And the differential diagnosis of bowel obstruction should cover ACS in order for the surgeon to be prepared before surgery.

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Hernioscopy Revealing Rare Abdominal Cocoon Syndrome in an Elderly Patient: A Novel Technique for Abdominal Pathology

Sun

et al. 2021

Am J Case Rep

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Patient: Male, 90-year-old Final Diagnosis: Abdominal cocoon syndrome Symptoms: Progressive abdominal pain, distension, and vomiting Medication:— Clinical Procedure: Surgical repair of bilateral hernias and hernioscopy Specialty: Gastroenterology and Hepatology • Surgery Objective: Rare coexistence of disease or pathology Background: Incarcerated inguinal hernias (IGHs) combined with abdominal cocoons (ACs) are uncommon in adults. Abdominal cavity exploration using laparoscopy via the hernial sac (hernioscopy) has rarely been reported. Here, an elderly man with unilateral IGH complicated by a contralateral inguinal hernia and AC was found using hernioscopy. We present the surgical decision-making points in an elderly patient with IGH, enrich the diversity of AC, and propose a relatively novel hernioscopy approach. Case Report: A 90-year-old man presented with chronic constipation and reducible right inguinal masses. A lump in the right groin was strangulated for 2 days, accompanied with progressive abdominal pain, distension, and vomiting. The levels of inflammatory markers were elevated. Abdominal computed tomography revealed a dilated small bowel and a large mass in the right groin. Subsequently, the patient’s condition quickly deteriorated. Therefore, he underwent surgical repair of bilateral hernias. Additionally, in our hospital, a total of 46 patients underwent hernioscopy because of IGH. No intraoperative or postoperative complications were observed. According to our clinical practice, hernioscopy via the bilateral hernial sacs was performed in this elderly patient. We found that almost the entire small bowel and colon were encapsulated in a fibrous and cocoon-like membrane, which postoperative pathological results revealed as AC. Conclusions: This is the first report to reveal that AC complicated with IGH could occur in a 90-year-old man. Hernioscopy is a relatively novel and safe surgical approach to abdominal pathology associated with incarcerated or strangulated inguinal hernias. It is rarely used in adults with IGH.

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Difficult to Diagnose the Cause of Intestinal Obstruction due to Abdominal Cocoon Syndrome

Cited by 4 publications

References 9 publications

Abdominal Cocoon Syndrome in a Liver Transplant Patient: A Case Report and Review of the Literature

Abdominal Cocoon Syndrome in a Liver Transplant Patient: A Case Report and Review of the Literature

Abdominal cocoon syndrome (ACS): a case report of a Chinese male diagnosed idiopathic ACS with inborn short intestine

Hernioscopy Revealing Rare Abdominal Cocoon Syndrome in an Elderly Patient: A Novel Technique for Abdominal Pathology

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