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Abdominal cocoon: precipitated by laparoscopic gas insufflation
  1. Karingattil George Mathew1,
  2. Shakeel Akhtar2 and
  3. Saajan Ignatius Pius3
  1. 1General Surgery, Emirates Hospital, Dubai, UAE
  2. 2Pathology, NMC Healthcare LLC, Dubai, UAE
  3. 3General Surgery, NMC Healthcare LLC, Dubai, UAE
  1. Correspondence to Dr Karingattil George Mathew; mathkg{at}


A young male in his early 30s presented to us with increasing swelling at the umbilicus, and an umbilical hernia was diagnosed. At laparoscopic intraperitoneal onlay mesh (IPOM) repair, an unexpected finding of a thin innocuous-looking fibrous film over the small bowel was noted. This finding presented a dilemma as to the probable pathology of this material, and a decision had to be made on whether laparoscopic IPOM could be continued. It was prudently decided to abandon the plan of placing a mesh intraperitoneally and an open repair of the umbilical hernia was done. In retrospect this was a wise decision, as, after 7 months he had to have a laparotomy for intestinal obstruction, when the classic thick fibrous encapsulating abdominal cocoon was seen. Hence here we have followed the evolution of the abdominal cocoon from its original asymptomatic phase to the classic encapsulating sclerosing peritonitis with probably laparoscopic gas insufflation being the precipitating factor.

  • gastrointestinal surgery
  • pathology

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  • Contributors KGM is the main author as well as the corresponding author. He has been the treating surgeon, and responsible for writing the article. SA has been responsible for studying and reporting the pathological slides. He has also contributed to reviewing the article and giving comments/modifications. SIP has worked closely with the main author in writing the article. He has also been responsible for coediting and uploading the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.