Answer to Q1

Tubercular Abdominal Cocoon

Tubercular abdominal cocoon is a form of peritoneal tuberculosis where small bowel loops get clumped together and sorrounded by a membrane. The entity is not very common but of importance because of difficulty in treatment and may require surgery. Recent data from PGI, Chandigarh (India) demonstrates efficacy of antitubercular therapy in symptomatic resolution. The surgical outcomes may also be marred by complications and need for ileostomies and enterotomies. Radiology is an important tool for diagnosis and the typical signs include cauliflower sign, concertina sign, bottle gourd sign.

Further reading : Sharma V, Singh H, Mandavdhare HS. Tubercular Abdominal Cocoon: Systematic Review of an Uncommon Form of Tuberculosis. Surg Infect (Larchmt). 2017 Aug/Sep;18(6):736-741.

Gorsi U, Gupta P, Mandavdhare HS, Singh H, Dutta U, Sharma V. The use of computed tomography in the diagnosis of abdominal cocoon. Clin Imaging. 2018 Jul – Aug;50:171-174. 29602067.

Sharma V, Mandavdhare HS, Rana SS, Singh H, Kumar A, Gupta R. Role of conservative management in tubercular abdominal cocoon: a case series. Infection. 2017 Oct;45(5):601-606.

Mandavdhare HS, Kumar A, Sharma V, Rana SS. Abdominal cocoon: An enigmatic entity. Tropical Gastroenterology 2016;37(3):156-167