In this case, a 19-year-old male patient had been diagnosed with bilateral cryptorchidism for bilateral scrotal emptiness 6 years earlier. The left testicle was removed by laparoscopic surgery, and the right testicle was lowered and fixed. The operation was successful. In December 2019, the patient was re-admitted to the hospital, due to abdominal pain accompanied by nausea and vomiting for 3 days. By examination, the abdomen was swollen, and tenderness but no rebound pain was reported around the umbilicus. The abdominal muscles were slightly tense, and bowel sounds were active approximately 6–7 times/minute. An abdominal plain film indicated that gases and liquids had accumulated in the intestine, and a visible liquid-gas level could be seen. Enhanced computed tomography (CT) of the abdomen suggested the possibility of mechanical obstruction at the level of the distal ileum. A routine blood test reported 16.63 * 10 ^ 9 / L white blood cells, 0.73 * 10 ^ 9 / L monocytes, 84.3% neutrophil percentage, and 14.02 * 10 ^ 9 / L neutrophils, suggesting the presence of infection. Based on the examination results in conjunction with the patient’s existing symptoms, signs, and previous medical history, the initial diagnosis was adhesion intestinal obstruction related to laparoscopic cryptorchidism surgery. An intestinal obstruction catheter was installed under emergency gastroscopy for conventional conservative treatment. After 2 weeks, the patient’s abdominal symptoms had improved significantly. Peristalsis and (minimal) defecation resumed, but the intestinal obstruction catheter remained at 170 cm without improvement. A total gastrointestinal angiography was performed to reconfirm the intestinal obstruction, and the results still indicated incomplete distal small bowel obstruction. Thus, conservative treatment was continued. Approximately 3 days later, the patient reported a sudden return of abdominal tenderness and intolerable pain. Reexamination of the whole abdominal CT showed that the intestinal effusion was more dilated than before, the gas-liquid level was elevated, the intestinal lumen had expanded and the intestinal obstruction was exacerbated, appearing as abnormal thickening of the small intestinal wall, as shown in Fig. 1.
Conservative treatment was ceased, and laparotomy was performed immediately to prevent intestinal necrosis. No greater omentum was found during surgery, with fibrous tissue seen instead on the surface of the intestine, which was tightly attached and wrapped around the intestine (see Fig. 2). In consideration of the patient’s history of cryptorchidism, he was diagnosed with congenital cryptorchidism with primary abdominal cocoon. The patient’s intestine could still be seen under the capsule, as the cocoon membrane is thin, although the extensive adhesions form fibrous bands. Intestinal adhesion release, intestinal decompression and intestinal alignment were performed; the operation went smoothly. On the 3rd day after surgery, the patient was able to defecate, and no notable discomfort such as bloating, pain, nausea or vomiting was reported at the 10th day after surgery. Consequently, the abdominal drainage tube and intestinal obstruction tube were removed. Bowel obstruction of the patient has not recurred and is still being followed up.