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IMAGES IN CLINICAL PRACTICE
Year : 2018  |  Volume : 4  |  Issue : 1  |  Page : 52-53

Solitary Massive Hydropneumoperitoneum in Abdomen Roentgenogram: A Pointer Toward Perforated Viscous in an Abdominal Cocoon


Department of Surgery, Maulana Azad Medical College, New Delhi, India

Date of Web Publication27-Mar-2018

Correspondence Address:
Manish K Mishra
Department of Surgery, Maulana Azad Medical College, New Delhi 110002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mamcjms.mamcjms_12_18

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How to cite this article:
Mishra MK, Vindal A, Lal P. Solitary Massive Hydropneumoperitoneum in Abdomen Roentgenogram: A Pointer Toward Perforated Viscous in an Abdominal Cocoon. MAMC J Med Sci 2018;4:52-3

How to cite this URL:
Mishra MK, Vindal A, Lal P. Solitary Massive Hydropneumoperitoneum in Abdomen Roentgenogram: A Pointer Toward Perforated Viscous in an Abdominal Cocoon. MAMC J Med Sci [serial online] 2018 [cited 2019 Aug 19];4:52-3. Available from: http://www.mamcjms.in/text.asp?2018/4/1/52/228647




  Case History Top


A 17-year-young girl was brought to surgical emergency with complaints of colicky pain lower abdomen, multiple nonbilious vomiting episodes and absolute constipation for 3 days. She had a history of laparotomy 2 years back for ileal perforation peritonitis. Histopathology of biopsied tissue was diagnostic for Koch’s. She took antitubercular treatment for 6 months (Category-I, extrapulmonary tuberculosis) from directly observed treatment short-course (DOTS) centre postoperatively.

On clinical examination, she was found to be dehydrated and tachycardic. Abdomen was tense, distended, diffusely tender with positive tap sign, suggestive of generalized peritonitis. Blood investigations were suggestive of septicemia. X-ray abdomen (erect) showed a single intra-abdominal massive air-fluid level [Figure 1]. Per-operatively there was abdominal cocoon [Figure 2] consisting of fibrous tissue and plastered bowel loops, which was incised to deliver the bowel inside releasing entrapped gas and feco-purulent content. A single perforation was found proximal to a nonpassable ileal stricture [Figure 3] approximately 60 cm proximal to ileocaecal junction. The segment of ileum containing stricture-perforation was resected and double barrel stoma was fashioned in the view of poor general condition and unhealthy bowel. Patient died on postoperative day 39 due to multiple organ dysfunction syndrome.
Figure 1: X-ray abdomen (erect) showing solitary massive hydropneumoperitoneum

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Figure 2: Abdominal cocoon encasing bowel perforation and pneumoperitoneum

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Figure 3: Site of bowel perforation

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Abdominal cocoon was first described by Owtschinnikow in 1907 as “peritonitis chronica fibrosa incapsulata.”[1],[2] Sarmast et al. have reported managing a patient with cocoon abdomen by laparotomy with adhesiolysis.[1]

[Figure 1] highlights a rare roentgenogram of massive hydropneumoperitoneum in clinical practice, indicator of bowel perforation in an abdominal cocoon.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sarmast AH, Showkat HI, Sherwani A, Kachroo MY, Parray FQ. Abdominal tuberculosis with a cocoon. Iran Red Crescent Med J 2012;14:503.  Back to cited text no. 1
[PUBMED]    
2.
Owtschinnikow PJ. Peritonitis chronica fibrosa incapsulata. Arch Klin Chir 1907;83:623-34.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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