Indian Journal of Surgery Medknow Publications on behalf of Association of Surgeons of India ISSN: 0972-2068 Vol. 66, Num. 4, 2004, pp. 241-241

Indian Journal of Surgery, Vol. 66, No. 4, July-August, 2004, pp. 241

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Abdominal cocoon: A rare cause of intestinal obstruction in two patients

Yucel AhmetF, Kocakusak Ahmet, Arikan Soykan, Koyuncu Adil

Haseki Education and Research Hospital, Surgery Clinic, Istanbul

Correspondence Address:Haseki Education and Research Hospital, Surgery Clinic, Istanbul

Code Number: is04059

Idiopathic abdominal cocoon (IAC) is a rare disease, encountered mainly in young adolescent girls in the initial years following menarche. In the literature the youngest patient with IAC is a 4-year-old girl. The oldest woman is a 17-year-old mother who underwent operation 6 weeks after giving birth . Rarely boys may also be afflicted by IAC .

A 15-year-old girl and a 38-year-old man with acute abdomen underwent laparotomy for mechanical intestinal obstruction; an abdominal cocoon was found and removed in both cases. The patients were discharged from the hospital without any complication.In IAC small intestines are encased in a white fibrotic sac that causes intestinal obstruction . According to the history of our female patient she had episodes of abdominal pain triggered by emotional factors since her child-hood,whereas our male patient was complaining of right upper quadrant pain every 4-5 months for 6 years. Beside multiple air-fluid levels in the direct abdominal radiographs, there was a sac encasing and pressing all of the small intestines demonstrated by computerized tomography [Figure - 1]. In both cases a fibrotic sac encasing all the small intestines was found intraoperatively [Figure - 2]. Pathological examinations revealed a white fibrous sac due to a possible congenital brid syndrome according to the microscopical findings in both patients.

IAC is thought to be a congenital peritoneal encapsulation arising from the visceral peritoneum. The occurrence in the initial years following menarche is a characteristic finding as our female patient. Our male patient is the oldest and is among very rare male sufferers in the literature. Removal of the cocoon was the operative modality chosen for our patients as the only known treatment method in the literature.

Copyright 2004 - Indian Journal of Surgery

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