IDDF2018-ABS-0236 Abdominal cocoon syndrome: a case report and review of related literature

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Abstract

Significance

Despite several cases reported worldwide, Abdominal Cocoon Syndrome still is a rare condition. No published reports have been found locally. And reminds us to always be prudent despite being presented with a common problem. The correct early diagnosis avoids the risk of complications. This report aims to keep us abreast of the current practices and recommendation by other countries and able to be better equipped in handling perioperative incidental findings of this entity prior to the end of surgery.

Clinical Presentation

We presented a case of a 30-year-old man subacute gastric outlet obstruction and lagged physical development not appropriate for age.

Management

Imaging revealed dilated stomach and duodenum, delayed barium transit from the stomach to ileum, and concomitant distal jejunal and proximal ileal obstruction. Initially treated as SMA syndrome, but after 2 attempts of conservative management failed, a diagnostic laparotomy was done. A surprising intraoperative findings revealed a thick membrane covering the entire small intestines sparing the duodenum. Adhesiolysis and removal of the membrane were made, releasing the trapped intestines. Histopathology confirmed the diagnosis. The patient was discharged 2 weeks post-operatively.

Recommendation

It is recommended to remain prudent in handling the common problem and always have a high index of suspicion. Maximise preoperative condition of the patient, decide when to do the definitive treatment, careful surgery, judicious postoperative care, and surveillance of possible complications is a must. Aetiology remains elusive, research on the relationship of prematurity at birth, smoking on the development of adhesions and membrane formation, the perinatal risk factor is recommended.

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