Case History: 55-year-old male with abdominal distension with pain for two weeks.
Case History: 55-year-old male presents with complaints of abdominal distension with pain for two weeks.
Figure 1. Contrast axial abdomen CT images. Gross ascites with centrally placed dilated small bowel loops encapsulated within peripherally enhancing thickened peritoneum. Ascending colon, descending colon, and sigmoid colon located outside the thickened enhanced peritoneum.
Figure 2. Contrast sagittal and coronal abdomen CT image. Retroperitoneal organs noted outside the thickened enhanced peritoneum. Gross ascites with centrally placed dilated small bowel loops encapsulated within peripherally enhancing thickened peritoneum also seen.
Abdominal cocoon is characterized by total or partial encasement of the small bowel by a fibrocollagenous cocoon-like sac.
It may occur in males also but in recent literature review, only four idiopathic cases in males have been reported.
Multiple etiologies for abdominal cocoon have been established, although the underlying pathogenesis is not fully understood.
Pathologically, the encasing membrane is normal peritoneum rather than the thick fibrous-collagen tissue seen in an abdominal cocoon
Peritoneal calcification and tethering of the small bowel loops are associated more specifically with sclerosing peritonitis than the other CT findings
The ability of CT to depict the cause of a small-bowel obstruction, with a sensitivity of 73%â95% for high-grade small-bowel obstruction, makes it an important diagnostic tool.