title: An association between transmesenteric internal hernia and abdominal cocoon syndrome: A case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Kanuni Sultan Süleyman Training and Research Hospital,Department of General Surgery, Istanbul, Turkey. Electronic address: issarici2015@gmail.com.
authors.forename: Tansu
authors.initials: T
authors.lastname: Altintas
authors.affiliation: Kanuni Sultan Süleyman Training and Research Hospital,Department of General Surgery, Istanbul, Turkey.
authors.forename: İnanç Şamil
authors.initials: İŞ
authors.lastname: Sarıcı
authors.affiliation: Kanuni Sultan Süleyman Training and Research Hospital,Department of General Surgery, Istanbul, Turkey.
authors.forename: Mustafa Uygar
authors.initials: MU
authors.lastname: Kalaycı
keywords: Abdominal cocoon syndrome; Acute abdomen; Case report; Ileus; Internal hernia