An association between transmesenteric internal hernia and abdominal cocoon syndrome: A case report

INTRODUCTION: Transmesenteric internal hernia is defined as the herniation of the small intestine from a mesenteric defect in the abdominal cavity, and abdominal cocoon syndrome is the partial or entire encapsulation of the small bowel like the shape of an accordion, by a fibrocollagenous membrane. PRESENTATION OF CASE: A 32-year old male patient applied with complaints of abdominal pain, nausea, and vomiting bile. Signs visualized in the abdominal computer tomography were as follows: gatto formation of the small intestinal loops and suspected of an internal hernia.In the operation, a membrane was detected encapsulating the entire intestine resembling a tube, making the intestines to appear like an accordion and an opening was present in the small intestinal mesentery. The intestine was separated from the defect, and placed in its normal anatomical position. The defect in the mesentery was closed and the encapsulating membrane was removed from small intestine. Intestinal resection was not required. DISCUSSION: Internal hernias comprise less than 1% of all intestinal obstructions, and are formed by the herniation of the intestine and mesentery into the opening of the visceral peritoneum or into the recessus. Abdominal cocoon syndrome is a disorder characterized by the partial or total encapsulation of the small intestine by a thick and fibrotic membrane. Preoperative diagnosis is very difficult and is generally diagnosed during laparotomy exploration. CONCLUSION: The association of internal herniation and abdominal cocoon syndrome is an extremely rare cause of mechanical intestinal obstruction. If not promptly diagnosed and treated, can lead to serious complications.