Laparoscopic management of abdominal cocoon

Abstract

“Peritonitis fibrosa incapsulata”, first described in 1907, is a condition characterized by encasement of the bowel with a thick fibrous membrane. This condition was renamed as “abdominal cocoon” in 1978. It presents as small bowel obstruction clinically. 35 cases of abdominal cocoon have been reported in the literature over the last three decades. Abdominal cocoon is more common in adolescent girls from tropical countries. Various etiologies have been described, including tubercular. It is treated surgically by releasing the entrapped bowel. We report a laparoscopic experience of tubercular abdominal cocoon and review the literature.

Abdominal Cocoon: A Case Series

“…The imaging features are, however, not pathognomonic. 10 Similar CT findings have been reported in some cases of paraduodenal hernias.…”

“…In view of the fact that tuberculosis is highly prevalent in our country, it is likely to have a role in the formation of adhesions in the peritoneal cavity due to retrograde infection via fallopian tubes from subclinical pelvic inflammatory disease/genito urinary tuberculosis. 10 The idiopathic or primary variety is probably caused by a subclinical viral peritonitis leading to the formation of acocoon or as an immunological reaction to gynaecological infections, or due to retrograde menstruation. It has been reported to primarily affect young females from tropical and subtropical regions.…”

An unusual case in surgical emergency: Abdominal cocoon and its laparoscopic management

“…[4] In our case, laparoscopy was a useful tool both for the definitive diagnosis and the treatment of this condition, leading to a favourable postoperative outcome.…”

Cocoon within an abdominal cocoon

“…Abdominal ultrasound or small bowel barium studies may show a ‘cauliflower’ appearance in which the intestinal loops are arranged in a concertina shape with a narrow base. A CT scan may show dilated ileal loops towards the centre of the abdomen, or even, encasement by a membrane (5). …”

“…However, it is often only at laparotomy (5) or during laparoscopy that the actual diagnosis is made, when part or whole of the small bowel is seen encased within a sac. Although the sac usually encases the small bowel, at times, it can extend to involve the colon, liver and even the stomach.…”