Fibrous membrane stripping combined with nasointestinal ileus tube for abdominal cocoon: A case report and literature review

Abdominal cocoon syndrome is a rare cause of small-bowel obstruction characterized by a fibro-collagenous membrane that surrounds the intestine. Here, we report a documented case in which extensive fibrous membrane stripping was combined with intraoperative placement of a transnasal intestinal decompression tube, achieving rapid recovery and durable patency. We describe a patient in his 60s with intermittent abdominal distension, colicky pain, and complete arrest of flatus and stool. Contrast-enhanced computed tomography revealed clustered jejuno-ileal loops enveloped by soft tissue density, raising suspicion of encapsulating peritonitis. Diagnostic laparoscopy identified a thick, whitish membrane that covered the stomach, whole small intestine, colon, and mesentery; after extensive adhesiolysis, the operation was converted to laparotomy for complete membrane stripping and placement of a transnasal intestinal decompression tube. Histology demonstrated proliferative fibrous tissue without IgG4-positive plasma cell infiltration, excluding IgG4-related disease. The patient resumed oral intake on postoperative day 2, was discharged on day 22, and remained asymptomatic with patent bowel loops on 3-month imaging. This case underscores the importance of cross-sectional imaging for early suspicion, supports a strategy of laparoscopic exploration followed by open decortication when necessary, and suggests that intraoperative nasointestinal tube placement may mitigate early recurrent obstruction.