Small bowel obstruction secondary to abdominal cocoon syndrome: Case report and review of the literature

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Publication Details

Journal
Heliyon
Published
2026-09-21
DOI
https://doi.org/10.1016/j.heliyon.2026.e45437
Primary Topic
Dialysis and Renal Disease Management
Type
article
Field-Weighted Citation Impact
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article

Small bowel obstruction secondary to abdominal cocoon syndrome: Case report and review of the literature

Marwen Sghaier, Imen Ben Ismail, Ayoub Zoghlami, Rime Amari et al.
Heliyon
Dialysis and Renal Disease Management
article

Small bowel obstruction secondary to abdominal cocoon syndrome: Case report and review of the literature

Marwen Sghaier, Imen Ben Ismail, Ayoub Zoghlami, Rime Amari, Hakim Zenaidi, Jassser Yaakoubi
article en

Abstract

Introduction Abdominal Cocoon Syndrome (ACS), also known as idiopathic sclerosing encapsulating peritonitis, is a rare cause of small bowel obstruction characterized by a fibrocollagenous membrane encasing the intestinal loops. Its preoperative diagnosis remains challenging due to nonspecific clinical and imaging findings. Although more commonly reported in young males from tropical regions, idiopathic forms can occur in older adults without predisposing factors. Case presentation We report the case of a 58-year-old male with no history of abdominal surgery or tuberculosis who presented with recurrent abdominal pain, distension, nausea, and vomiting for three months. Computed tomography revealed clustered small-bowel loops with a transition zone in the right iliac fossa. After unsuccessful conservative management, exploratory laparotomy demonstrated the small intestine enveloped in a thick, whitish fibrous membrane. Complete adhesiolysis and membrane excision were performed without bowel resection. The postoperative course was uneventful. Discussion ACS is a rare entity that should be suspected in cases of recurrent or unexplained small bowel obstruction. Although computed tomography may suggest the diagnosis through the characteristic "cauliflower sign," surgical exploration remains the gold standard for confirmation and treatment. A review of the recent literature (2015–2024) shows that most patients achieve excellent outcomes following adhesiolysis and membrane excision, whether by open or laparoscopic approach. Conclusion In patients with recurrent, unexplained small bowel obstruction, ACS should be considered. Early surgical intervention ensures definitive treatment and prevents complications.

HeliyonVol. 12(15)
Tunis El Manar University (TN)
Good health and well-being
Openalex Percentile: Top 11%
Dialysis and Renal Disease Management
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