For citation purposes: Habibi M, Ozdemir S, Demirci E, Calis H, Bulbuller N. Partial abdominal cocoon in an elderly man. OA Surgery 2014 Feb 22;2(1):4.

Case report

 
Lower GI Surgery

Partial abdominal cocoon in an elderly man.

M Habibi, S Ozdemir, E Demirci, H Calis, N Bulbuller
 

Authors affiliations

(1) Antalya Training and Research Hospital, Antalya, Turkey

(2) Antalya Memorial Hospital, Antalya, Turkey

(3) Patnos State Hospital, Agri, Turkey

* Corresponding author Email: manihabibi@gmail.com

Abstract

Introduction

Abdominal cocoon, an idiopathic form of sclerosing encapsulating peritonitis (SEP), is a rare fibrocollagenous membrane-forming process that results in total or partial encapsulation of the small intestine. Patients may present with signs of acute and subacute small bowel obstruction, the cause of which is a thick fibrous cap covering the small intestines. Abdominal cocoon is more commonly observed in young female patients. Here we present our identification and treatment of a case of partial abdominal cocoon in an elderly man after initial diagnosis of incarcerated inguinal hernia in which the cause of obstruction was a rotation between encapsulated intestinal segments.

Case report

An 81-year-old man admitted to emergency department with the clinical findings of bowel obstruction. Subsequent palpation of the inguinal hernia sac during physical examination revealed incarceration. Under spinal anaesthesia, right inguinal incision was performed and exploration at the level of the internal inguinal ring revealed adherent abdominal bowel loops that joined together to form a mass. Upon this observation, general anaesthesia was administered for full exploration by laparotomy. Rotation between two different intestinal segments resulting in the formation of a cocoon-like mass covered with stiff fibrotic tissue was identified as the cause of mechanical bowel obstruction. Dissection of the adhesions on the level of rotation provided for continuity of the passage.

Conclusion

The main surgical approach for treating abdominal cocoon is lysis of adhesions and excision of the stiff membranes. Resection is only indicated in case of nonviable or perforated bowel.

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