Abdominal cocoon due to primary peritonitis: barium meal is valuable in diagnosis.

ABSTRACT

Abdominal cocoon, a rare condition in which the small bowel is encased in a membrane, resembles peritoneal fibrsis. There are only 16 case reports of this condition in the world literature. A 15-year-old girl presented with recurrent abdominal pain due to distal small bowel obstruction. Abdominal X-ray showed multiple air fluid levels like small intestinal obstruction. Contrast study revealed segregation of the small bowel loops with a dilatedproximal small intestine and gradual narrowing of the distal ileum with the obstruction; the mucosal pattern was preserved till the distal ileum. Contrast was not flowing into the colon. At laparotomy, the small intestine was seen to be encased and coiled up in a membrane. The membrane was excised, resulting in release of the obstruction.