A RARE ETIOLOGY OF INTESTINAL OBSTRUCTION: ABDOMINAL COCOON SYNDROME

Semra Demirli ATICI,Tayfun KAYA,Yasemin KIRMIZI,Can ARICAN,Erdal HARMANDA,Cengiz AYDİN

Özet

Introduction: Abdominal cocoon syndrome is one of the rare causes of intestinal obstruction, intestinal hemorrhage, and perforation. The small bowel is encapsulated completely or particularly by the fibro-collagenous membrane which was called the abdominal cocoon and it was reported mainly in young adolescent women as a cause of small bowel obstruction. Preoperative diagnosis is very difficult and most common it was diagnosed as the abdominal cocoon with preoperative findings. Case: A 46-year-old male patient admitted emergency service with abdominal pain, no gas, and stool discharge. His physical examination was compatible with acute abdomen and mechanic intestinal obstruction. He was hospitalized and operated with the presumptive diagnosis of intestinal obstruction. Operative findings were consistent with abdominal cocoon, adhesiolysis was performed. Patient’s postoperative course was unremarkable, and he was discharged on postoperative 8th day. Follow-up 28 months showed no clinical evidence of recurrence. The pathology was reported as fibrosis, inflammation and fibrin exudation, compatible with the abdominal cocoon. Conclusion: Here in, we present the etiology, management and the treatment of abdominal cocoon syndrome which was a rare cause of mechanic bowel obstruction among male patients and difficult to diagnose preoperatively.

Abstract

Giriş: Abdominal koza sendromu intestinal obstruksiyon, intestinal hemoraji ve perforasyonun nadir görülen sebeplerinden biridir. Abdominal kozada incebarsaklar tamamen veya kısmen abdominal koza olarak adlandırılan fibrokollajenöz yapıda bir membranal kaplı olup, bu hastalık daha çok genç adölesan kadınlarda intestinal obstruksiyon sebeplerinden biri olarak bildirilmiştir. Preoperatif tanı koymak güç olup, genellikle peroperatif bulgular eşliğinde tanı konulabilmektedir. Olgu:46 yaşında erkek hasta, acil servise karın ağrısı, bulantı, kusma ve gaz gayta çıkaramama şikayetleri ile başvurdu. Fizik muayenesi akut batınve mekanik barsak obstruksiyonu ile uyumluydu. Hasta intestinal obstruksiyon ön tanısı ile acil operasyon amaçlı hospitalize edildi. Peroperatif görünümü abdominal koza ile uyumlu olduğu saptandı ve bridektomi yapıldı. Hastanın postoperative takibi sorunsuz seyretti ve postopreatif sekizinci gün taburcu edildi. Hastanın postoperative 28 aylık takibinde klinik olarak nüks bulgusu gözlenmedi. Patoloji spesimeni, inflamasyon, fibrozis, fibrin eksudaları şeklinde olup, abdominal koza sendromu ile uyumlu olarak raporlandı. Sonuç: Biz burada, nadir bir mekanik barsak obstruksiyonu sebebi olup, erkeklerde daha nadir görülen, preoperative teşhisi zor olan abdominal koza sendromunu, etyolojisini ve tedavi yönetimini sunmayı planladık.