Abstract
Abdominal cocoon syndrome or encapsulating peritoneal sclerosis is a rare condition causing small bowel obstruction. It is called cocoon syndrome because of the existence of an abnormal membrane that contains part or the entire small intestine. We present a case of a 49-year-old male, presenting to our department with recurrent episodes of obstructive ileus that did not respond to conservative treatment. He underwent exploratory laparotomy and a thick membrane covering the small bowel loops was found. The membrane was excised and sent for pathological examination. Abdominal cocoon syndrome is an acquired condition caused by an inflammatory process that is not yet completely understood. There are many theories for the pathophysiology of the disease. In most cases, the diagnosis is established during surgery. Complete removal of the membrane is the indicated surgical treatment. In mild cases, when the diagnosis is made preoperatively, conservative treatment should be the first choice.
Highlights
There are reports in the literature about the existence of an abnormal membrane encapsulating the intestine since 1968 [1]
Abdominal cocoon syndrome known as primary sclerosing encapsulating peritonitis is a rare cause of small bowel obstruction [2]
In 1968, Cleland described a disease with the name peritoneal encapsulation [1,2,4]. He reported the presence of an additional peritoneal membrane, which is supposed to be derived from the yolk sac peritoneum [4]
Summary
There are reports in the literature about the existence of an abnormal membrane encapsulating the intestine since 1968 [1]. A 49-year-old male experienced recurrent obstructive ileus, counting two admissions in our department within three months, treated conservatively The third time he underwent an exploratory laparotomy when all conservative measures failed. The patient experienced incapacity of feeding properly and was malnourished During hospitalization he was supported with parenteral nutrition and a decision of laparotomy was made, as no amelioration of his condition was observed with conservative measures. The pathology report of the membrane revealed connective tissue with the presence of inflammatory cells One week after he was discharged, the patient experienced retching and vomiting when consuming liquids, while surprisingly he could tolerate eating solid food. There was a high suspicion of cocoon syndrome and the histological results would confirm the diagnosis He denied admission and visited another institution, where he underwent another laparotomy
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