A rare case of abdominal cocoon

Abstract

Abdominal cocoon is a rare cause of intestinal obstruction usually diagnosed incidentally at laparotomy. It mani- fests by forming a membrane that typically encases the small bowel loops, leading to mechanical obstruction. Preoperative diagnosis is difficult. The etiology of this condition is not well understood; however, it is a form of chronic irritation and inflammation. METHOD: A 33 years old male, from Bangladesh, presented to our emergency department complaining of abdominal pain, nausea, and vomiting. CT abdomen shows a picture of intestinal obstruction at the level of the small intestine. Intraoperative findings showed encapsulation of small bowel by a dense whitish membrane as a cocoon. Histological exam- ination showed a granulomatous peritonitis and Ascaris Lumbricoides in the bowel resected. RESULTS AND CONCLUSIONS: The preoperative diagnosis of abdominal cocoon is difficult and hence, the diagnosis is usu- ally confirmed by laparotomy. Surgery remains the cornerstone in the management of abdominal cocoon. The pathogen- esis of abdominal cocoon remains elusive and has been associated with several conditions. The initial diagnosis of our patient was bowel obstruction from cocoon syndrome (CT and intraoperative findings) probably primitive, and only his- tologically proved granulomatous peritonitis associated with the presence of the parasite.