Snapshot quiz 19/7
Authors: Goh S and Goo J
This patient has a rare cause of intestinal obstruction known as idiopathic abdominal cocoon. An abdominal cocoon is also known as sclerosing peritonitis, where a dense fibrotic sac encases the bowel (small and/or large bowel) leading to intestinal obstruction. Idiopathic abdominal cocoon occurs in patients with no previous abdominal surgery. It is most commonly reported in young girls in tropical countries, and may be the result of previous subclinical peritonitis (1). In this patient, at operation, a thin transparent sac was seen to encase the small and large bowel, with dense interloop adhesions resulting in a transition point at mid-ileum. Extensive adhesiolysis was performed and the bowel was healthy after sac release. Seprafilm® (Sanofi, Paris, France) was placed before closure of the wound.
1 Li N, ZhuW, Li Y, Gong J, Gu L, Li M et al. Surgical treatment and perioperative management of idiopathic
abdominal cocoon: single-center review of 65 cases. World J Surg 2014; 38: 1860–1867.