MSS853: THE DOUBLE OBSTRUCTION: A CASE REPORT OF INCIDENTALLY FOUND ABDOMINAL COCOON SYNDROME DURING EXPLORATION FOR CECAL BASCULE
Trey K Nettles, MD; Justin G Hale, DO; Salvatore Parascandola, MD; Eisenhower Army Medical Center
Idiopathic sclerosing encapsulating peritonitis, also known as Abdominal cocoon syndrome (ACS), and cecal bascule are two distinct and rare pathologies that can cause intestinal obstruction. We present a case report of a 35-year-old female with a history of a treated ovarian yolk sac tumor who presented to the Emergency Department with acute worsening of chronic abdominal pain and signs of bowel obstruction. Initial contrast enhanced computed tomography findings were suggestive of a cecal bascule and concomitant high grade small bowel obstruction. Exploratory laparotomy revealed a dense, fibrous cocoon-like sac encasing a significant portion of the proximal and mid small intestine creating a chronic, partial small bowel obstruction. Additionally, a folded and obstructed cecum consistent with a cecal bascule causing an acute large bowel obstruction was identified. The patient underwent an extensive adhesiolysis and partial right colectomy with primary anastomosis. After surgery the patient recovered without complication and was doing well on follow up with complete resolution of her bowel complaints. This case report highlights the diagnostic challenges of these rare pathologies and describes the successful surgical management of this unique dual presentation. Idiopathic sclerosing encapsulating peritonitis, or abdominal cocoon syndrome, is an exceedingly rare cause of intestinal obstruction worldwide. To our knowledge this is the first reported case of simultaneous abdominal cocoon syndrome and cecal bascule, underscoring the importance of considering multiple rare etiologies in patients with obstructive symptoms.