Abstract
The abdominal cocoon is a rare clinical entity characterized by a thick fibrocollagenous membrane encasing the intestinal loops. Despite its rarity, the abdominal cocoon is one of the most serious complications of peritoneal dialysis. We report the case of a 45-year-old man, with end-stage renal disease on peritoneal dialysis resulting from systemic lupus erythematosus, who presented to the emergency department with progressive abdominal pain for the last two weeks. The pain was associated with nausea, vomiting, abdominal distension, and decreased bowel motion. Upon examination, the vital signs were within the normal limits. Abdominal examination revealed a distended abdomen with generalized tenderness. There was evidence of ascites as indicated by the positive shifting dullness test. The bowel sounds were of increased frequency and intensity. The laboratory findings were non-contributory. The patient underwent an abdominal computed tomography scan that demonstrated a cluster of small intestinal loops in the middle of the abdomen with a surrounding thick and calcified membrane. This made the diagnosis of the abdominal cocoon. The patient underwent an operation to resect the fibrocollagenous membrane. The patient reported improvement after the operation. No recurrence was noted after three months of follow-up. Abdominal cocoon is a very rare complication of peritoneal dialysis. The diagnosis of abdominal cocoon should be kept in mind when the physician encounters a patient with peritoneal dialysis who presented with non-specific and unexplained gastrointestinal symptoms.
Highlights
Abdominal cocoon syndrome is a pathological condition that is characterized by the formation of a thick fibrocollagenous membrane encasing the intestinal loops [1]
The most important risk factors for the development of abdominal cocoon syndrome are the previous history of peritonitis and the duration of peritoneal dialysis [1]
We reported the case of a middle-aged man with end-stage renal disease who developed abdominal cocoon syndrome after 15 years of peritoneal dialysis
Summary
Abdominal cocoon syndrome is a pathological condition that is characterized by the formation of a thick fibrocollagenous membrane encasing the intestinal loops [1]. It is a rare complication of continuous ambulatory peritoneal dialysis with a reported incidence of less than one per 1000 patient-years [2]. We present the case of a middle-aged man with an abdominal cocoon that developed after 15 years of peritoneal dialysis. The patient was diagnosed as having systemic lupus erythematosus at the age of 21 years He developed lupus nephritis resulting in end-stage renal disease. Such findings conferred the diagnosis of an abdominal cocoon (Figure 1). After three months of follow-up, the patient remained asymptomatic with no evidence of recurrence
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
