Published online May 28, 2016. doi: 10.3748/wjg.v22.i20.4958
Peer-review started: February 14, 2016
First decision: March 7, 2016
Revised: March 15, 2016
Accepted: April 7, 2016
Article in press: April 7, 2016
Published online: May 28, 2016
Abdominal cocoon syndrome (ACS) is a rare cause of intestinal obstruction due to total or partial encapsulation of the small intestine by a fibrocollagenous membrane. Idiopathic ACS with abdominal cryptorchidism and greater omentum hypoplasia is even rarer clinically. We successfully treated a 26-year-old male case of small bowel obstruction with acute peritonitis. He was finally diagnosed with idiopathic ACS with unilateral abdominal cryptorchidism and greater omentum hypoplasia during exploratory laparotomy. He then underwent enterolysis, cryptorchidectomy, and appendectomy. He recovered gradually from the operations and early postoperative inflammatory ileus. There has been no recurrence of intestinal obstruction since the operation, and he is still in follow-up. We analyzed his clinical data and retrospectively reviewed the literature, and our findings may be helpful for the clinical diagnosis and treatment on ACS.
Core tip: Abdominal cocoon syndrome (ACS) is a rare abdominal disease where a portion or all of the abdominal organs are wrapped in a dense membrane-like fibrous tissue. Intestinal obstruction is the main clinical manifestation of ACS. Because of its rarity and lack of characteristic symptoms, ACS is fairly difficult to diagnose pre-operatively. Surgeons should be aware of this disease when confronted with a case of intestinal obstruction whose abdominal radiography shows intestinal loop aggregation cluster. Accompanying cryptorchidism is possible, and a careful physical examination and operative exploration for the undescended testicle should be performed. Postoperative care and dietary guidance are very important to the rehabilitation of ACS patients. Postoperative re-adhesion and early postoperative inflammatory ileus easily occur after extensive enterolysis.