Agenesis of the greater omentum with primary abdominal cocoon: not an acquired condition

AUTHOR(s) : Ganguly NN, Baro AC, Rongpi R, Bhuyan R
DOI No. : 10.31741/ijhrmlp.v8.i2.2022.10


Background and aims: Agenesis of the greater omentum and the primary abdominal cocoon is rare. It is characterized by total or partial encasement of the small bowel inside a membranous bag. We report four cases of primary cocoon-causing intestinal obstruction. Materials and methods: Primary abdominal cocoons are the cause of intestinal obstruction. In this condition, the small intestine, in part or whole, is encased inside a glistening membranous sac. The first case we encountered in 1998 was at the Gauhati Medical College and Hospital (GMCH), Guwahati, Assam. It was presented at a local conference and in the Journal of the Association of the Surgeons of Assam. Long 21 years passed before we faced another case of agenesis of the greater omentum with primary abdominal cocoon causing acute dynamic small bowel obstruction in the Jorhat Medical College and Hospital (JMCH) in Jorhat, Assam. Later in quick succession, we had two more cases; one was diagnosed preoperatively by the Contrast Enhanced Computerized Tomography (CECT) abdomen. All these cases were explored for unresolved obstruction, and on the table, findings suggested the primary abdominal cocoon. The findings were compared with the first case encountered in 1998. The other cases and the peculiarities were noted, especially the agenesis of the greater omentum and the presence of free peritoneal bodies. Photographs were taken. Results: The patients were operated upon as emergency exploratory laparotomy, and the Sac was excised. All recovered well. The one patient diagnosed by the CECT awaits intervention as she improved on conservative therapy. Conclusion: The literature reports a primary abdominal cocoon with agenesis of the greater omentum. We suggest the condition is not acquired as the agenesis of the greater omentum association in all cases proves that this syndrome is congenital. The presence of the Sac without any cellular component is an enigma.

Keywords: Intestinal obstruction; agenesis; hypoplasia; greater omentum, primary cocoon.

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