Intestinal Obstruction Caused by Abdominal Cocoon in Intestinal Malrotation: Report of a Case

Abstract

The abdominal cocoon is a rare condition of unknown etiology that primarily affects adolescent girls living in tropical and subtropical regions. It is seldom suspected preoperatively, and the patients usually present with the typical symptoms and signs of intestinal obstruction. This paper reports a 46-year-old male who presented with vomiting and intermittent epigastric pain for several hours. Intestinal obstruction with echogenic materials in the lumen was found on abdominal sonography, and computed tomography of the abdomen showed small intestinal obstruction coupled with suspected colonic malrotation. Exploratory laparotomy showed a huge cystic mass measuring 20×30 cm, with small intestinal loops encased in a transparent, fibrous capsule, located in the upper and mid-abdomen. The whole small intestine was located on the right side, and the large bowel on the left side of the abdominal cavity. Lysis of adhesions and the cystic wall was easily done, which successfully freed the entrapped bowel loops. Other than dilatation, the intestinal loops looked grossly normal, therefore no resections were done. Histology of the specimen from the capsule and adhesions revealed only fibrosis and congestion. The postoperative course was smooth and uneventful, and the patient was discharged 16 days after surgery. Now, at the time of this writing, 15 months after the operation, the patient is living a normal life. The purpose of this case report is to remind the readers that this disease can occur even in adult males.