Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2024; 16(3): 955-965
Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.955
Abdominal cocoon syndrome-a rare culprit behind small bowel ischemia and obstruction: Three case reports
Witcha Vipudhamorn, Tawan Juthasilaparut, Pawit Sutharat, Suwan Sanmee, Ekkarin Supatrakul
Witcha Vipudhamorn, Pawit Sutharat, Suwan Sanmee, Ekkarin Supatrakul, Department of Colorectal Surgery, Chiang Mai University, Chiang Mai 50200, Thailand
Tawan Juthasilaparut, Department of Surgery, Lampang Hospital, Lampang 52000, Thailand
Co-first authors: Witcha Vipudhamorn and Tawan Juthasilaparut.
Author contributions: Vipudhamorn W and Juthasilaparut T contributed to manuscript writing and editing, and data collection; Sutharat P, Sanmee S and Supatrakul E contributed to conceptualization and supervision; all authors have read and approved the final manuscript. Notably, Vipudhamorn W and Juthasilaparut T, as doctors directly involved in the care of the patients featured in this case report, not only spearheaded the drafting of the manuscript but also contributed their clinical insights and expertise. While Vipudhamorn W and Juthasilaparut T took the lead in composing the manuscript, Sutharat P, Sanmee S, and Supatrakul E diligently reviewed articles for discussion and contributed significantly to the revision process. Furthermore, all authors played integral roles in the critical review of the results, collectively ensuring the accuracy and validity of the final manuscript, which has been unanimously approved by the entire team. Vipudhamorn W and Juthasilaparut T are designated as co-first authors for several compelling reasons. Firstly, their involvement extended beyond writing; their direct patient care and clinical insights profoundly influenced the depth and context of this study. Secondly, both Vipudhamorn W and Juthasilaparut T made substantive and equal contributions throughout the research process, reflecting the essence of teamwork and dedication. In essence, designating Vipudhamorn W and Juthasilaparut T as co-first authors aptly reflects the collaborative spirit, equal contributions, and clinical expertise they brought to this manuscript. Their direct involvement with the patients, combined with their writing efforts, significantly enriched the depth and authenticity of this study, thereby enhancing its value to the medical community.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Witcha Vipudhamorn, FRCS (Gen Surg), Surgeon, Department of Colorectal Surgery, Chiang Mai University, No. 110 Intavaroros, Sripoom, Maung, Chiang Mai 50200, Thailand. witcha.vip@cmu.ac.th
Received: November 26, 2023
Peer-review started: November 26, 2023
First decision: December 15, 2023
Revised: December 16, 2023
Accepted: February 6, 2024
Article in press: February 6, 2024
Published online: March 27, 2024
Processing time: 116 Days and 22.5 Hours
Core Tip

Core Tip: Diagnosing Abdominal cocoon syndrome (ACS) poses challenges, often necessitating laparotomy for confirmation. This study presents three distinct ACS cases: one featuring bowel obstruction, another with isolated ischemia, and the last highlighting disparities between radiological findings and surgical assessments. Preoperative computed tomography scans played a crucial role in diagnosis, revealing diverse manifestations such as capsules encasing the bowels, mesenteric congestion, or ambiguous obstructions. Surgical excision of encapsulating structures led to successful recovery. Additionally, one case involved a traumatic event, requiring exploratory laparotomy a year later, where no fibrosis was found around the previously removed intestine. Early clinical suspicion, coupled with precise radiological examination, aids in identifying ACS before surgery. Complete removal of the sac during obstruction/ischemia is the established approach, recommending resection solely for confirmed ischemic complications.