Small Bowel Necrosis Research Articles

Clinical Outcome and Predictors of Intestinal Obstruction Surgery in Ethiopia: A Cross-Sectional Study.

Background Despite the advancement in the healthcare system, the impact of surgical interventions on public health systems will continue to grow. But predicting the outcome is challenging. Concerns related to unexpected outcomes and delays in the diagnosis of postoperative complications are the major issue. Intestinal obstruction is a common life-threatening surgical condition followed by fatal and nonfatal postoperative complications. This study was aimed at assessing results after surgery for intestinal obstruction in a hospital of Ethiopia. Methodology. An institutional-based cross-sectional study was conducted among 254 postoperative patients admitted with intestinal obstruction from January 1, 2014, to December 31, 2017. Data were coded and entered into EpiData 4.2.0.0 software and exported to the Statistical Package for the Social Sciences version 22 for analysis. A binary logistic regression model was used for analysis. All variables with a p value < 0.25 during bivariable analysis were considered for multivariable logistic regression analysis. Results The magnitude of poor surgical outcome of intestinal obstruction was 21.3% for patients enrolled into this investigation. The age group of ≥55 years (adjusted odds ratio (AOR) = 2.9, 95% CI: 1.03, 8.4), duration of illness of ≥24 hrs (AOR = 3.1, 95% CI: 1.03, 9.4), preoperative diagnosis of a gangrenous large bowel (AOR = 3.6, 95% CI: 1.3, 9.8), and a gangrenous small bowel (AOR = 4.2, 95% CI: 1.3, 13.7) were significantly associated with poor surgical outcome. Conclusions The magnitude of poor surgical outcome was high. Age, late presentation of illness, and gangrenous bowel obstructions were significantly associated with poor outcomes. So, concern should be given in early detection and follow-up of patients who came late and older patients.

Management of Acute Mesenteric Venous Thrombosis: A Systematic Review of Contemporary Studies.

Background and Aims:Acute mesenteric venous thrombosis accounts for up to 20% of all patients with acute mesenteric ischemia in high-income countries. Acute mesenteric venous thrombosis is nowadays relatively more often diagnosed with intravenous contrast-enhanced computed tomography in the portal phase than at explorative laparotomy No high-quality comparative studies between anticoagulation alone, endovascular therapy, or surgery exists. The aim of the present systematic review was to offer a contemporary overview on management.Materials and Methods:Eleven relevant published original studies with series of at least ten patients were retrieved from a Pub Med search between 2015 and 2020 using the Medical Subject Heading term “mesenteric venous thrombosis.”Results:When MVT is diagnosed early, immediate anticoagulation with either unfractionated heparin or subcutaneous low-molecular-weight heparin should commence. Surgeons need to be aware of the importance to scrutinize the computed tomography images themselves for assessment of secondary intestinal abnormalities to mesenteric venous thrombosis and the risk of bowel resection and worse prognosis. Progression toward peritonitis is an indication for explorative laparotomy and assessment of bowel viability. Frank transmural small bowel necrosis should be resected and bowel anastomosis may be delayed for several days until second look. Meanwhile, intravenous full-dose unfractionated heparin should be given at the end of the first operation. Postoperative major intra-abdominal or gastrointestinal bleeding occurs rarely, but the heparin effect can instantaneously be reversed by protamine sulfate. Patients who do not improve during conservative therapy with anticoagulation alone but without developing peritonitis may be subjected to endovascular therapy in expert centers. When the patient’s intestinal function has recovered, with or without bowel resection, switch from parenteral unfractionated heparin or low-molecular-weight heparin therapy to oral anticoagulation can be performed. There is a trend that direct oral anticoagulants are increasingly used instead of vitamin K antagonists. Up to now, direct oral anticoagulants have been shown to be equally effective with the same rate of bleeding complications. Patients with no strong permanent trigger factor for mesenteric venous thrombosis such as intra-abdominal cancer should undergo blood screening for inherited and acquired thrombophilia.Conclusion:Early diagnosis with emergency computed tomography with intravenous contrast-enhancement and imaging in the portal phase and anticoagulation therapy is necessary to be able to have a succesful non-operative succesful course.

A Case Report and Literature Review: Grape Seeds Causing Meckel’s Diverticulitis, Perforation and Small Bowel Obstruction in a Young Adult Patient

Background: Meckel’s diverticulum is a true diverticulum consisting of a 3-layered outpouching of the bowel wall along the antimesenteric border. It is a remnant of the omphalomesenteric duct and the most common congenital gastrointestinal disorder. It has a male predilection and remains asymptomatic in the majority of cases. It constitutes a diagnostic challenge to physicians, as it can present with gastrointestinal bleeding in the pediatric population, and as an intestinal obstruction in adults. While the management of an asymptomatic Meckel’s diverticulum is on a case-by-case basis, when symptomatic, prompt surgical intervention is necessary, and a laparoscopic approach allows both in-situ diagnosis and treatment. Case Report: A 23-year-old previously healthy female patient, presented with diffuse abdominal pain, vomiting, and obstipation. Abdominal X-Ray and abdominopelvic Computed Tomography showed an intra-abdominal inflammatory process and evidence of bowel obstruction but were not conclusive. The patient was admitted to the hospital for management, and on the third day of hospitalization physical examination showed abdominal guarding suggestive of peritonitis. An urgent exploratory laparotomy identified a Meckel’s Diverticulum obstructed with phytobezoar grape seeds, and an inflamed and perforated bowel wall, with adhesive bands to proximal small bowel loops, necrosis, and resultant small bowel obstruction. We resected the Meckel’s diverticulum and the necrotic bowel and performed an end-to-end primary anastomosis of the small bowel. The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day. Conclusion: The diagnosis of Meckel’s diverticulum remains a challenge as it has a myriad of clinical presentation and radiological imaging sometimes fails to provide a definite diagnosis. It must be systematically included in the differential diagnosis of small bowel obstruction in adult patients, as it requires prompt surgical intervention for both diagnosis and treatment.

Nonocclusive mesenteric ischemia associated with postoperative jejunal tube feeding: Indicators for clinical management.

Postoperative nutrition via a jejunal tube after major abdominal surgery is usually well tolerated. However, some patients develop nonocclusive mesenteric ischemia (NOMI). This morbid complication has a grave prognosis with a mortality rate of 41% to 100%. Early symptoms are nonspecific, and no treatment guideline is available. We reviewed cases of NOMI at our institution and cases described in the literature to identify factors that impact the clinical course. Among five patients, three had no necrosis and one had segmental necrosis and perforation. These patients recovered with limited resection and decompression of the bowel and abdominal compartment. In one patient with extended bowel necrosis at the time of re-laparotomy, NOMI progressed and the patient died of multiple organ failure. The extent of small bowel necrosis at the time of re-laparotomy is a relevant prognostic factor. Therefore, early diagnosis and treatment of NOMI can improve the prognosis. Clinical symptoms of abdominal distension, cramps and high reflux plus paraclinical signs of leukocytosis, hypotension and computed tomography findings of a distended small bowel with pneumatosis intestinalis and portal venous gas can help to establish the diagnosis. We herein introduce an algorithm for the diagnosis and management of NOMI associated with jejunal tube feeding.

Gastrointestinal Complications in Critically Ill Patients With COVID-19.

Extrapulmonary disease has been observed in patients with coronavirus disease 2019 (COVID-19).1–3 We describe here the gastrointestinal (GI) complications of patients with severe COVID-19 admitted to the intensive care unit (ICU) at the Massachusetts General Hospital between March 13 and April 12, 2020. During this time period, 141 patients were admitted to the ICU with severe acute respiratory syndrome coronavirus 2 infection confirmed by reverse-transcriptase–polymerase-chain-reaction testing. The median (interquartile range) age was 57 (47, 70) years, 65% of them were men, and 45% had GI symptoms (eg, abdominal pain, diarrhea, vomiting) on hospital presentation (Table 1). The median (interquartile range) Sequential Organ Failure Assessment Score upon admission to the ICU was 5 (4, 7.5), and 128 (91%) required mechanical ventilation. A total of 104 patients (74%) developed at least 1 GI complication.TABLE 1: Characteristics of Patients With Severe Coronavirus Disease 2019 Admitted to the Intensive Care UnitWe stratified the GI complications into 4 categories: hepatobiliary, hypomotility, bowel ischemia, and other. Among the hepatobiliary complications, transaminitis was the most common (67%). The mean highest values recorded for aspartate aminotransferase and alanine aminotransferase were 420.7 and 479.0 U/L respectively, representing a 7.5- and 12-fold increase from the physiological values. Four patients (4%) developed acute acalculous cholecystitis and 1 patient (1%) developed acute pancreatitis during their ICU stay. Half of the patients developed hypomotility-related complications of variable severity. Almost all patients with GI complications required nasogastric or orogastric tubes. Forty-six percent of patients had gastric feeding held for at least 24 hours due to high gastric residuals, and 58 (56%) developed an ileus diagnosed clinically and/or radiologically. Four of the patients with severe ileus had clinical and radiologic findings concerning for bowel ischemia and were taken to the operating room on days 11, 14, 15, and 22 of hospitalization, respectively, for an exploratory laparotomy. Two patients were found to have extensive patchy bowel necrosis involving half to two thirds of the total bowel length, despite patent proximal mesenteric vessels on the computed tomography scan, perhaps suggesting microvascular thrombosis. Intraoperatively, the necrotic bowel had a distinct bright yellow color in contrast to the common finding of purple-black color [(Fig. 1 in the Supplementary Appendix (Supplemental Figure 1. Diffuse patchy areas of necrosis of the entire small bowel and right colon, involving large and short stretches of the wall. Note the clear demarcation, the round shape, and the antimesenteric location, https://links.lww.com/SLA/C197)]. Another patient was found to have ischemia without frank necrosis of the terminal ileum. The fourth patient developed liver ischemia and necrosis, and had similar areas of yellow discoloration on the antimesenteric side of the small bowel, without frank transmural necrosis. Two additional patients were diagnosed with a colonic paralytic ileus, clinically identical to colonic pseudoobstruction (Ogilvie syndrome) on days 6 and 14 of hospitalization. Figure 2 in the Supplementary Appendix (Supplemental Figure 2. Abdominal x-ray of a patient with an Ogilvie-like syndrome showing significant distention of the colon, https://links.lww.com/SLA/C198.) shows an abdominal x-ray of 1 of these 2 patients demonstrating significant colonic dilation with cecal wall pneumatosis. On exploratory laparotomy, patchy areas of necrosis of the entire colon were noted; a total colectomy and an end ileostomy were performed. The pathology of the resected bowel showed focal transmural areas of necrosis with acute fibrinopurulent serositis. The overall 14-day patient mortality was 15%. The mortality rate of the subset of patients who required abdominal surgery was as high as 40%. In this series of critically ill patients with COVID-19, we report a high incidence of hepatobiliary, hypomotility, and ischemic GI complications. Of 141 patients, 58 had ileus, 2 had an Ogilvie-like syndrome, 1 had extensive hepatic necrosis, and 4 had bowel ischemia necessitating emergent surgery and bowel resection. Although these GI complications could be attributed to pharmacologic adverse events and metabolic and electrolyte disturbances occasionally encountered in critically ill patients, severe acute respiratory syndrome coronavirus 2–induced small vessel thrombosis or viral enteroneuropathy are 2 possible hypotheses that warrant further investigation.4,5 In summary, critically ill COVID-19 patients have a high incidence of GI complications with a subset that progress to bowel ischemia requiring emergent surgical intervention. Front-line clinicians should be made aware of these complications and should keep a high index of suspicion for GI symptoms warranting surgical consultation.

118 Small Bowel Necrosis Associated with a Single Dose Kayexalate Treatment in a Patient with Chronic Sevelamer Therapy

118 Small Bowel Necrosis Associated with a Single Dose Kayexalate Treatment in a Patient with Chronic Sevelamer Therapy

Potential Therapeutic Approaches for the Intussusception Through a Side-to-Side Jejunojejunal Anastomosis After Laparoscopic Gastrectomy.

We reviewed our experience with the management of intussusception presenting as a complication of laparoscopic gastrectomy (LG) and studied the feasibility of a laparoscopic intervention to treat or prevent this condition. We retrospectively analyzed the data of 12 patients diagnosed with intussusception, following gastrectomy, from 2008 to 2017, including clinical manifestations, incidence, post-LG time-interval before diagnosis, and treatment. Totally, 12/2300 gastrectomy patients (0.52%) developed intussusception. All 12 had undergone laparoscopic distal gastrectomy for gastric cancer (12/1250, 0.96%) and presented with intussusception through a side-to-side jejunojejunal anastomosis. The mean latency period was 423.8 (range: 86 to 1500) days. Four patients underwent emergent laparoscopic reduction of the efferent loop without bowel resection, along with fixation of the reduced jejunum to the afferent loop and the small bowel mesentery, to prevent a recurrence. One patient required open surgery with manual reduction and segmental resection of the gangrenous small bowel portion. All operated patients recovered without any complications. Intussusception resolved spontaneously in the remaining 7/12 patients. We found that a laparoscopic approach can be used for preventing or managing post-LG intussusception. We found that recurrence can be prevented or treated by anchoring and fixing the (reduced) efferent loop to the afferent loop and the small bowel mesentery.

Occlusion intestinale sur nœud iléo-sigmoïdien chez une femme en post-partum : à propos d'un cas et revue de la littérature

Introduction: Ileosigmoidal knotting (ISK) is the wrapping of the ileum around the sigmoid colon and its mesentery or vice-versa and is a rare cause of intestinal obstruction in immediate postpartum. Observation: We report a case of ileo-sigmoid volvulus with intestinal necrosis; in which the diagnosis of the ISK was only made during surgical exploration. The treatment consisted in resection of gangrenous small bowel and performed small bowel anastomosis with sigmoidopexy and the postoperative course was uneventful. Through this case, we would like to discuss the diagnostic, therapeutic and prognostic aspects of this rare entity with a literature review. Conclusion: The rapid progression to intestinal necrosis of this type of postpartum occlusion is responsible for high maternal-fetal mortality, which requires rapid and adequate surgical management.

Abdominal Angina and Intestinal Gangrene-Catastrophic Presentation of Thrombosis of Common Hepato-SplenoMesenteric Trunk (HSMT): A Rare Case Report

Middle age patient was presented in emergency department with complains of acute abdominal pain, vomiting and diarrhea. On clinical examination there was board like rigidity and tender abdomen. Initial labs were unremarkable. Filling defect was seen in an anomalous channel, hepato-spleno-mesenteric trunk that was seen as a supply of liver, spleen, small bowel and part of large bowel on contrast enhanced computed tomography. The left gastric artery was seen arising separately from aorta. Emergency exploratory laprotomy was done. Patchy discoloration and cyanosis with friability was seen in liver and spleen representing ischemia. Gangrene of small bowel and proximal large bowel (till the splenic lexure) was seen. The patient expired few days after presentation. No other surgical intervention was done. This was an unusual case of abdominal angina due to thrombosis of a rare arterial variation of gastrointestinal vascularity. The hepato-spleno-mesenteric trunk was seen thrombosed which happens to be the only artery supplying the midgut and its embryological visceral derivatives in the subjects it occur in. However, in cases like these there is a possibility of collateral supply from esophageal, phrenic and inferior mesenteric arteries.

Patchy Necrosis of Small Bowel

Sepsis, vasopressors and infective endocarditis have been usually implicated as a causative factor for small bowel ischaemia. We present intra-operative image showing multiple necrotic patches over small bowel in a patient of traumatic superior mesenteric vessel injury.

2528 Extensive Small Bowel Ischemia With Heavy Alcohol Consumption

INTRODUCTION: Acute mesenteric ischemia (AMI) is a disorder associated with atherosclerosis and cardiovascular disorders. It includes a range of disease etiologies including nonocclusive mesenteric ischemia (NOMI). NOMI is the most lethal form of AMI with mortality rates up to 70%. Alcohol is well recognized as a systemic toxin that causes serious health problems. Intestinal complications caused by alcohol consumption, however, are not well documented. We present a rare case of a patient who developed NOMI following excessive alcohol consumption. CASE DESCRIPTION/METHODS: A 52-year old male presented with a chief complaint of abdominal pain. The abdominal pain began after uncharacteristically drinking 11 shots of hard liquor. The patient developed abdominal pain along with several bouts of emesis. Initial imaging with a CT abdomen demonstrated non-specific enteritis. Later that evening, the patient developed peritoneal signs. A repeat CT abdomen showed progressive proximal small bowel distension, free fluid in the abdomen and pelvis along with pneumatosis in the proximal ileum (Figure 1). Surgery revealed frank necrosis, gangrene and extreme distension of small bowel, 20 cm proximal to the ileocecal valve. The ischemic small bowel was resected as a result. The proximal and distal ends of the small bowel were stapled and left in discontinuity. Pathology collected from the small bowel resection revealed acute inflammation and both mucosal necrosis along with transmural gangrenous necrosis of the small bowel (Figure 2). It additionally showed patent mesenteric vessels without evidence of fibrin thrombi (Figure 3). The patient subsequently underwent a small bowel anastomosis and was discharged. DISCUSSION: NOMI secondary to excessive alcohol binging has only been reported in the literature only once before. Similar to the case reported in the Journal of the Korean Society of Coloproctology, there was no history of CVD or atrial fibrillation to suggest thrombotic or embolic mesenteric ischemia. Additionally, there were no findings suggestive of correlating mesenteric involvement on pathology. Of note, our case differed in that our patient did not have a significant alcohol abuse history which the previously reported case had noted. Studies in the literature suggest that ethanol can produce prolonged vasoconstriction in cerebral blood vessels which become involved in hypoxic, ischemic and hemorrhagic actions on the brain. However, mechanisms of alcohol-induced vasoconstriction of splanchnic vessels are still unclear.

2033 Gastrointestinal Bleeding: A Rare Manifestation of Renal Cell Carcinoma

INTRODUCTION: We describe a rare cause of gastrointestinal bleeding in a patient with metastatic renal cell carcinoma (RCC) and discuss consideration and workup of this manifestation, as it is becoming more common given improved survival of this patient cohort. CASE DESCRIPTION/METHODS: A 65-year-old male with history of RCC treated with left nephrectomy complicated by local recurrence and pancreatic tail involvement, on nivolumab, presented with melena and dyspnea. Vitals were notable for orthostasis, melena on rectal exam, and labs revealed a Hgb of 5.6 gm/dL. After resuscitation, the patient underwent push enteroscopy and colonoscopy which did not reveal a source. The following day, the patient developed large volume hematochezia with lightheadedness, hypotension, and acute blood loss anemia requiring transfusion. Given his negative endoscopy and known metastatic RCC, CT angiogram was performed demonstrating an enhancing left upper quadrant soft tissue mass invading into the small bowel lumen. Interventional Radiology was consulted and recommended against embolization due to high risk of small bowel necrosis. Subsequently, Surgery was consulted and requested video capsule endoscopy, but the patient deteriorated requiring emergent surgery. An ileal mass, confirmed to be metastatic RCC, was resected. The patient had no further bleeding and was discharged home; he continues to follow closely with Oncology. DISCUSSION: Metastases to the small bowel are a rare cause of GI bleeding, but are often due to malignancies of the breast, cervix, lung, and melanoma. RCC metastatic to the small bowel has only been described in case reports thus far, but may become more common. Advances in targeted chemotherapeutics of the VEGF and mTOR pathways lead to improved survival and thus, more opportunities for metastases. Patients may present with intussusception, bowel obstruction, or GI bleeding alone, with bleeding favored by their vascular nature. Patients will undergo extensive upper and lower endoscopic evaluation without localizing the source, prompting cross-sectional imaging which is more sensitive for confirming the diagnosis. Surgery is often required, as tumors supplied by branches of the mesenteric arteries pose significant risk of small bowel infarction if embolized. In patients with known history of RCC who present with GI bleeding, small bowel metastases should be considered as an etiology if endocscopy is negative, and obtaining CT imaging urgently may lead to timely management of such lesions.

Internal hernia with Roux loop gangrene in a post

High degree suspicion is mandatory in dealing with a post-operative patient presenting with a crampy postprandial abdominal pain, as potential for internal hernias remains fairly under diagnosed. Except in setting of small bowel obstruction or gangrene and radiological proven internal hernia, intervening a patient with herald symptoms is still debatable, though certain authors advocate that in lap. Roux-en Y gastric bypass patients with herald symptoms should promptly be offered elective laparoscopic exploration elective repair safely and expeditiously.

Unusual presentation of hyperhomocysteinaemia

Acute portomesenteric vein thrombosis is an uncommon but serious condition with potential sequelae, such as small bowel gangrene and end-stage hepatic failure. Here we describe a rare association of hyperhomocysteinaemia with isolated portomesentric thrombosis. A 39-year-old gentleman presented

Unusual presentation of hyperhomocysteinaemia

Acute portomesenteric vein thrombosis is an uncommon but serious condition with potential sequelae, such as small bowel gangrene and end-stage hepatic failure. Here we describe a rare association of hyperhomocysteinaemia with isolated portomesentric thrombosis. A 39-year-old gentleman presented

An Uncommon An Uncommon Cause of Acute Abdomen in Underprivileged Communities

Oftentimes general surgeons working in poorly resourced communities carry out emergency abdominal surgery in patients with acute abdomen with no definitive preoperative diagnosis. The definitive diagnosis is made at laparotomy. Perforated small bowel obstruction secondary to heavy Infestation with Ascaris Lumbricoides brings a number of intraoperative challenges requiring correct intraoperative surgical management decisions. We present a case of a 17 year-old patient who was admitted with a diagnosis of small bowel obstruction who at laparotomy was found to have perforated gangrenous small bowel volvulus with heavy worm load visible through the bowel wall. Because of faecal peritoneal contamination and haemodynamic instability she underwent a two staged procedure with good outcome.

Laparoscopic Resection of Gangrenous Small bowel with acute small bowel obstruction – World’s First reported case

Introduction: Diagnostic laparoscopy is now frequently used for small bowel obstructionwith a varying degree of success. However, emergency laparoscopic resection ofgangrenous small bowel has not yet been reported in the English literature. We reportthe world first case of successful laparoscopic assisted resection of gangrenous smallbowel in a 64 year old female with an excellent postoperative outcome.Presentation of Case: A 64 years old woman with a virgin abdomen presentedwith a clinical and radiological features of small bowel obstruction. The patient washemodynamically stable with mild central abdominal distension and tenderness butthere was no guarding or rebound tenderness. On diagnostic laparoscopy a loop ofgangrenous small bowel was noted secondary to an adhesion band. The patient had asuccessful laparoscopic assisted resection and extra-corporal anastomosis of the smallbowel with an excellent postoperative outcome.Discussion: Diagnostic laparoscopy plays a vital role for the diagnosis and treatmentof selected cases of small bowel obstruction in a virgin abdomen. However, appropriatepatient selection as well as the availability of a skilled laparoscopic surgeon is offparamount importance for a successful outcome. Contrast enhanced CT scan is alsoa useful tool for appropriate patient selection. The morbidity of laparotomy can oftenbe avoided in presence of a skilled laparoscopic surgeon.Conclusion: Laparoscopic approach can be attempted in selected patients with firstepisode of SBO and/or anticipated single band obstruction. Similarly, gangrenoussmall bowel can be resected laparoscopically in highly selected patients in the presenceof an experienced laparoscopic surgeon.

Study of morbidity and mortality after ileostomy in gangrenous small bowel perforations

Study of morbidity and mortality after ileostomy in gangrenous small bowel perforations

Small Bowel Necrosis After Colonoscopy

Small Bowel Necrosis After Colonoscopy

Abdominal cocoon syndrome: A rare cause of acute abdomen syndrome.

A rare cause of acute abdomen or intestinal obstruction, the abdominal cocoon syndrome is also described in the literature as sclerosing peritonitis or sclerosing encapsulating peritonitis. Abdominal cocoon is characterized by the total or partial wrapping of the abdominal organs by a fibrous membrane. Although it is usually observed in young women, the etiology is unknown. The diagnosis is usually made during laparotomy. In this case series, we aimed to present seven patients diagnosed with abdominal cocoon syndrome during operation. The records of patients who underwent laparotomy for abdominal pain and/or intestinal obstruction in our hospital and diagnosed as abdominal cocoon during operation between January 2012 and November 2018 were retrospectively reviewed. The demographic characteristics of the patients, etiologic factors, surgical procedures, operative findings and follow-up of the patients were recorded. Four out of seven patients who were operated for abdominal cocoon were male and 3 of them were female. The median age of patients was 61 (57-63) years in male and 39.6 (28-49) years in female. Six of the patients were operated in emergency conditions with the diagnosis of an acute abdomen or ileus. One of the patients was operated with the diagnosis of an intra-abdominal mass in elective conditions. In five out of seven patients, all of the small intestines were wrapped with a fibrous collagen capsule, while two of the patient intestines were partially wrapped with a fibrous collagen capsule. Four of the patients had no underlying disease, while one of the patients had Familial Mediterranean Fever (FMF), one had Endometriosis and one had beta-blocker medication. One patient who had small bowel necrosis and septic peritonitis were observed during the operation and died post operative 6th days. Postoperative complications were not observed in the follow-up of other patients and reoperation was not required due to recurrence. Abdominal cocoon is a condition that is usually diagnosed during operation in patients that were operated for reasons, such as the acute abdomen or intestinal obstruction. When the diagnose delayed, death can be seen due to small bowel necrosis and septic complications. High clinical suspicion and radiological imaging are important in the preoperative diagnosis. Treatment is required adhesiolysis and excision of the fibrous membranes.