Abdominal cocoon syndrome, a rare and interesting cause of intestinal obstruction: A case report

Key clinical message: Abdominal cocoon syndrome is a rare cause of bowel obstruction, with variable presentation. It needs a high index of suspicion for diagnosis. Surgical management with the release of adhesions is the preferred option for a healthy bowel. Iatrogenic bowel perforation is a possibility during bowel manipulation and the release of thick fibrous adhesions resulting in bowel resection.

Abstract: Abdominal cocoon syndrome, also known as encapsulating peritoneal sclerosis, is a rare cause of intestinal obstruction in which the small intestine may be entirely or partially wrapped in a thick sac of fibrous tissue that resembles a cocoon. We present a male Ethiopian patient, 60 years of age, who had a 6-day history of symptoms of intermittent intestinal obstruction. Before his current presentation, he had a 6-month history of sporadic vomiting and periodic abdominal pain. These symptoms would go away on their own. An exploratory laparotomy was performed for the preoperative diagnosis of small intestine obstruction secondary to primary small bowel volvulus after a plain abdomen x-ray confirmed the small bowel obstruction diagnosis. But during surgery, we discovered something unexpected: a mass formed by the encasing membrane over the small bowel. En bloc resection of the mass and distal ileum with ileo-transverse anastomosis was performed. The patient was discharged after 5 days of an uneventful post-operative stay. The morbidity and mortality of this rare instance can be decreased by awareness, prompt diagnosis, and appropriate intervention. We discuss diagnostic and therapeutic challenges encountered during the management of this patient.