A case report of abdominal cocoon syndrome and literature review

doi:10.3969/j.issn.1004-583X.2023.09.010

Abstract

Abstract:

Objective To investigate the diagnosis and treatment of the rare abdominal cocoon syndrome (AC) by a case report. Methods Clinical data of a case of AC were analyzed retrospectively, and the relevant literatures were reviewed. Results A 72-year-old male patient presented with nausea, vomiting and abdominal pain. Double-contrast radiography of the upper gastrointestinal tract suggested the incomplete intestinal obstruction of the upper segment of the intestine. The abdominal CT suggested the suspected AC. Consequently, the exploratory laparotomy was performed, and we found that the stomach, small intestine, colon and mesentery were all surrounded by fibrous capsules. Ultimately, intestinal adhesiolysis was carried out, and the patient’s condition improved and discharged. Conclusion Clinical manifestations of AC are atypical. Affected patients usually ask for medical help due to clinical symptoms of intestinal obstruction like nausea, vomiting and failure of defecation and gas pass. Its diagnosis depends on the history medical, imaging examinations and even exploratory laparotomy. Surgery is the most effective therapeutic strategy for AC, which effectively alleviates the clinical symptoms and signs.

Key words: abdominal cocoon, fibrous capsule formation, intestinal obstruction

CLC Number:

R572.2

Wang Xiaoting, Wang Yan, Feng Zhijie, Yao Dongmei, Yang Xincheng, Qiu Shaofan, Li Meng, Tian Hui. A case report of abdominal cocoon syndrome and literature review[J]. Clinical Focus, 2023, 38(9): 827-831.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.09.010

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I9/827

Figures/Tables 8

Fig. 1 Double-contrast radiography of the upper gastrointestinal tract shows duodenal dilation, suggesting the incomplete intestinal obstruction of the upper segment of the intestine

Fig. 2 Gastroscopy shows congestion and edema of the mucosa of the gastric fundus, and a large amount of yellow-green gastric contents

Fig. 3 The abdominal CT shows that the outside intestine is surrounded by fibrous capsules (indicated by arrows)

Fig. 4 Enteroscopy shows the widening of the horizontal part of duodenum and the initial portion of the jejunum. With the continuous gas insufflation, intestinal dilation is restricted

Fig. 5 Intestinal ultrasound shows local small bowel stasis in the mid-upper abdomen with peripheral mesangial thickening

Fig. 6 During intestinal adhesiolysis, white membranous structures can be seen wrapped around the intestinal tube, resembling a “silkworm cocoon” (indicated by arrows)

Fig. 7 Fibrous tissue stripped during surgery

Fig. 8 Pathology shows fibrocystic tissues

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