Abdominal Cocoon Syndrome: A Rare Cause of Intestinal Obstruction

Joana Frazão,Ana Rita Martins,António Godinho,José Calado

doi:10.7759/cureus.22929

Joana Frazão, Ana Rita Martins + Show 2 more

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https://doi.org/10.7759/cureus.22929

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Journal: Cureus	Publication Date: Mar 7, 2022
Citations: 1	License type: cc-by

Affiliation: Hospital Prof. Dr. Fernando Fonseca

Abstract

Abdominal cocoon syndrome, also known as Sclerosing Encapsulating Peritonitis, is characterized by a fibro-collagenous membrane that involves abdominal viscera and it’s a rare cause of intestinal obstruction.We present here two cases. Two male patients, 29 and 75 years old, were admitted to our emergency department with abdominal pain, vomiting, tender and painful abdomen but without changes in intestinal transit or peritoneal reaction. They were treated surgically and diagnosed with abdominal cocoon syndrome.Patients with abdominal cocoon syndrome usually present with recurrent episodes of intestinal obstruction, which result from the compression of the bowel within the constricting cocoon. Most of the time, this clinical picture resolves with conservative measures, delaying the diagnosis. The definitive treatment consists of excision of the membrane with lysis of adhesions, which is usually reserved for more severe cases of obstruction.This is a rare disease, where a high suspicion index is of paramount importance, especially considering that most of the diagnoses are made at the surgery.

Highlights

Abdominal cocoon syndrome, known as Sclerosing Encapsulating Peritonitis, is a rare entity and an extremely uncommon cause of intestinal obstruction
Two variants exist: primary and secondary, which is mostly seen in patients with a history of tuberculosis, neoplasm, beta-blockers use, peritoneal dialysis or previous abdominal surgery [4]
Plain abdominal X-ray (Figure 3) showed small bowel air-fluid levels and the abdominal CT scan (Figure 4) showed dilation of bowel loops with a minimal quantity of fluid present, suggesting an intestinal obstruction. This obstruction did not resolve with conservative measures, so the patient underwent exploratory laparotomy where an elastic membrane covering the entire small bowel was found (Figure 5)

Summary

Introduction

Known as Sclerosing Encapsulating Peritonitis, is a rare entity and an extremely uncommon cause of intestinal obstruction. A 75-year-old male patient, without past known diseases, presented with abdominal pain, nausea and vomiting, albeit with normal intestinal transit He had a history of several past admissions to our Emergency Department with the same complaints that were solved with conservative measures. A previously healthy 29-year-old male patient presented with diffuse abdominal pain and vomiting, but with preserved bowel movement He had a previous clinical history of several admissions to our Emergency. Plain abdominal X-ray (Figure 3) showed small bowel air-fluid levels and the abdominal CT scan (Figure 4) showed dilation of bowel loops with a minimal quantity of fluid present, suggesting an intestinal obstruction This obstruction did not resolve with conservative measures, so the patient underwent exploratory laparotomy where an elastic membrane covering the entire small bowel was found (Figure 5). The patient was discharged on the ninth post-operatory day, and after that he evolved favorably

Discussion

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Disclosures