Tubercular Abdominal Cocoon: Systematic Review of an Uncommon Form of Tuberculosis.

BACKGROUND Abdominal cocoon formation is an uncommon manifestation of abdominal tuberculosis that is characterized by the formation of a fibrous membrane-like sac around the small intestinal loops. Appropriate treatment and outcomes are uncertain Objectives: To review the clinical presentation, treatment, and outcomes for tubercular abdominal cocoon (TAC). PATIENTS AND METHODS We included studies published in the English language and listed in EMBASE or PubMed. All case series or reports that reported patients with TAC were considered for inclusion. Details regarding demographic, clinical presentation, and treatment received were tabulated. RESULTS The clinical features included predominantly abdominal pain, abdominal distension and features of intestinal obstruction, loss of appetite, and weight loss. The diagnosis was usually established at surgery, however, computed tomography was a useful tool. In most patients the treatment reported was surgical, however, conservative therapy with anti-tubercular therapy (ATT) did succeed in a subset of patients. The published literature includes only case series and reports. The outcomes, especially long-term outcomes, have not been reported in most studies. CONCLUSION Abdominal cocoon is an uncommon form of abdominal tuberculosis and conservative management with ATT may suffice in some patients whereas non-responsive cases require surgery.