Abstract
The idiopathic variant of sclerosing Intraperitoneal fibrosis is a rare pathological entity causing intestinal obstruction. Even though it is described since the beginning of the last century, we are still clueless about the aetiology of this problem. The presentation is often confusing and the clinical and laboratory values will be not confirmatory to establish a diagnosis. A Contrast-enhanced CT scan is a vital investigation of choice. Here we discuss a case of intestinal obstruction with a preop diagnosis of internal herniation, which turned out to be a case of massive intraperitoneal fibrosis. The histopathology was not significant, and no secondary cause was identified. The case report throws wisdom into the existence of this entity and how with a CT scan we can suspect it before surgery. With adequate and meticulous enterolysis we can surgically rehabilitate these patients so that they can lead a normal life.
Highlights
Idiopathic Abdominal cocoon (IAC) is an intraoperative pathology that is very rare in clinical practice
Case report We present a case of a 62-year-old man who presented to the surgical emergency department with complaints of distension of the abdomen and inability to pass stool or gas for 48 hours
Abdominal Tuberculosis workup was done with Polymerase Chain Reaction (PCR) for mycobacterium, manteaux test and Cartridge Based Nucleic Acid Amplification Test (CB-NAAT) Sputum were negative
Summary
Idiopathic Abdominal cocoon (IAC) is an intraoperative pathology that is very rare in clinical practice. This entity was first observed by Owtschinnikow in 1907 and vividly described by Foo et al in 1978 [1]. The abdomen was distended with absent bowel sounds He was admitted and started on parenteral intravenous fluid resuscitation. An abdominal radiograph revealed multiple air-fluid levels suggestive of small bowel obstruction. Abdominal Tuberculosis workup was done with Polymerase Chain Reaction (PCR) for mycobacterium, manteaux test and Cartridge Based Nucleic Acid Amplification Test (CB-NAAT) Sputum were negative He was managed conservatively with nasogastric decompression with a nasogastric tube, intravenous fluids, and symptomatic drugs. A gastrointestinal transit study after three months revealed normal functioning of the gut
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