COCOON ABDOMEN-A RARE PRESENTATION OF ABDOMINAL TUBERCULOSIS: A CASE REPORT

Abstract

Background:
Abdominal cocoon (sclerosing encapsulating peritonitis) is a rare disorder, characterized by fibrous encapsulation of the loops of small bowel. Although generally idiopathic, secondary causes can include tuberculosis, especially in endemic areas.
Case Presentation:
We report a rare case of an isolated abdominal tuberculous of a 26-year-old man with a 9-month history of high-grade fever, loss of weight, and generalised weakness, pyrexia of unknown origin and diffuse epigastric pain with radiation to the whole abdomen. On examination, he was pale and had temporal wasting, and signs of ascites with shifting dullness. Though Gene Xpert and AFB smear were negative, the analysis of ascitic fluid was exudative with highly raised adenosine deaminase (ADA) levels. CT-scan imaging showed encapsulated small bowel loops surrounded by chronically thickened peritoneum and moderate ascites consistent with abdominal cocoon due to tuberculosis. First- line anti-tuberculous therapy (ATT) was begun. The patient shows clinical improvement with substantial weight gain and disappearance of the symptoms after nine months of therapy. Follow-up CT-scan showed resolution of encapsulation and ascites.
Conclusion:
Abdominal cocoon is an extremely rare form of tubercular presentation that has to be treated urgently by diagnosis and then can be effectively treated conservatively with ATT if diagnosed early. This case emphasizes the need for integration of clinical, biochemical, and radiological findings for prompt, non-operative management in endemic regions.
Keywords
Abdominal cocoon, Anti-tuberculous therapy (ATT), Ascitic fluid, Sclerosing encapsulating peritonitis, Tuberculosis