Abdominal Cocoon Syndrome following Primary Subfertility Management with IVF-ET

Asmita Pandey,Chanda Karki,Meena Thapa

doi:10.31729/jnma.3683

Abstract

Abdominal cocoon syndrome is a rarely encountered surgical emergency first described by Foo et al. in 1978. This condition is characterised by a thick fibrous membrane which encases the small bowel partially or completely. Diagnosis of this condition is usually made per operatively and the treatment of choice is surgical release of entrapped bowel. This is a case report of abdominal cocoon syndrome diagnosed during laparotomy done with the provisional diagnosis of abdominal pregnancy following In vitro fertilization- embryo transfer. A 30 Years lady was admitted at Kathmandu Medical College for suspected ovarian hyper stimulation syndrome following In vitro fertilization- embryo transfer. Conservative treatment was done as the first line of management. Failing this, she was treated surgically with the provisional diagnosis of abdominal pregnancy. Abdominal cocoon syndrome was observed intraoperatively. Patient was managed medically with injection due to raised βhCG level and empty uterine cavity. Intrauterine gestational sac was seen after about seven weeks of In vitro fertilization- embryo transfer. Pregnancy was terminated medically and patient was discharged. Sub fertility is a common gynecological problem. Its management may sometimes produce challenging health hazards. Thorough screening for medical and surgical illness is very important before proceeding to any kind of assisted reproductive technologies. A multidisciplinary approach is very important to manage such cases. Keywords: abdominal cocoon syndrome; embryo transfer; In Vitro fertilization; ovarian Hyper stimulation syndrome; sub fertility.

Highlights

Abdominal cocoon syndrome is a rarely encountered surgical emergency first described by Foo et al in 1978.1 Bowel obstruction is a common surgical emergency
A diagnosis of abdominal cocoon syndrome was made during laparotomy (Figure 2)
abdominal cocoon (AC) with infertility belongs to tubal infertility; cause might be encapsulation of fallopian tube and ovaries within fibrous membranes, which limits the activity of fallopian tube and its function of picking up eggs or conveying gametes

Summary

Introduction

Abdominal cocoon syndrome is a rarely encountered surgical emergency first described by Foo et al in 1978.1 Bowel obstruction is a common surgical emergency. At times, unusual cases of bowel obstruction such as abdominal cocoon (AC) may be encountered. Karki et al Abdominal cocoon syndrome following primary sub fertility management with IVF-ET Rare case of abdominal cocoon syndrome diagnosed during laparotomy done with the provisional diagnosis of abdominal pregnancy following IVT-ET in a case of primary subfertility, trying to conceive for 10 years with features of acute mechanical intestinal obstruction.

Results

Conclusion