Abdominal Cocoon in an Elderly Woman

Abstract

Abdominal cocoon is a rare disease characterized by total or partial encasement of the small bowel by a thick fibrous membrane. The etiology of this disease is unknown. We report a case of strangulated ileus caused by abdominal cocoon. A 77-year-old woman presented with persistent abdominal pain. Enhanced abdominal CT revealed a cluster of dilated jejunal loops with ascites surrounded by a thick sac-like structure. Emergency laparoscopic surgery was performed under a diagnosis of a strangulated ileus. The dilated jejunum loops were found to be encased in a thick fibrous membrane. Laparoscopic surgery was suspended and minimum laparotomy was carried out to reduce the risk of accidental damage to the small bowel and ascertain the membrane. After total excision of the membrane, the jejunum loops were viable and needed no resection. The postoperative period was uneventful and the patient was discharged after 2 weeks. No recurrence has been observed during follow-up.