Hernioscopy Revealing Rare Abdominal Cocoon Syndrome in an Elderly Patient: A Novel Technique for Abdominal Pathology

Patient: Male, 90-year-old Final Diagnosis: Abdominal cocoon syndrome Symptoms: Progressive abdominal pain, distension, and vomiting Medication:— Clinical Procedure: Surgical repair of bilateral hernias and hernioscopy Specialty: Gastroenterology and Hepatology • Surgery OBJECTIVE: Rare coexistence of disease or pathology BACKGROUND: Incarcerated inguinal hernias (IGHs) combined with abdominal cocoons (ACs) are uncommon in adults. Abdominal cavity exploration using laparoscopy via the hernial sac (hernioscopy) has rarely been reported. Here, an elderly man with unilateral IGH complicated by a contralateral inguinal hernia and AC was found using hernioscopy. We present the surgical decision-making points in an elderly patient with IGH, enrich the diversity of AC, and propose a relatively novel hernioscopy approach. CASE REPORT: A 90-year-old man presented with chronic constipation and reducible right inguinal masses. A lump in the right groin was strangulated for 2 days, accompanied with progressive abdominal pain, distension, and vomiting. The levels of inflammatory markers were elevated. Abdominal computed tomography revealed a dilated small bowel and a large mass in the right groin. Subsequently, the patient’s condition quickly deteriorated. Therefore, he underwent surgical repair of bilateral hernias. Additionally, in our hospital, a total of 46 patients underwent hernioscopy because of IGH. No intraoperative or postoperative complications were observed. According to our clinical practice, hernioscopy via the bilateral hernial sacs was performed in this elderly patient. We found that almost the entire small bowel and colon were encapsulated in a fibrous and cocoon-like membrane, which postoperative pathological results revealed as AC. CONCLUSIONS: This is the first report to reveal that AC complicated with IGH could occur in a 90-year-old man. Hernioscopy is a relatively novel and safe surgical approach to abdominal pathology associated with incarcerated or strangulated inguinal hernias. It is rarely used in adults with IGH.