Revisiting the enigmatic abdominal cocoon

Abstract

Abdominal cocoon, the idiopathic form of sclerosing encapsulating peritonitis (SEP) is a rare condition of unknown etiology that results in intestinal obstruction due to partial or total encapsulation of the small bowel by a thick fibrotic membrane in a concertina like fashion, hence the name cocoon. It primarily affects adolescent girls living in tropical and subtropical regions. The early clinical features and findings of imaging diagnostic tools are non specific and difficult to make definitive diagnosis preoperatively. Surprisingly, with proper surgical management, there is complete recovery and recurrence-free later life. We report an unusual presentation in an elderly female who presented with acute intestinal obstruction. The diagnosis could be made only peroperatively when on laparotomy the entire small bowel was cocooned and enclosed in a yellowish white fibrotic membrane resulting in obstruction of small intestine. The membrane was carefully peeled off the intestines and adhesiolysis was done. Patient had complete recovery. Histopathology report was consistent with the diagnosis of primary abdominal cocoon. We are reporting this case so that surgeons are better aware of this condition as a possible cause of intestinal obstruction to facilitate preoperative diagnosis and prevent unnecessary bowel resection at laparotomy for good surgical outcome.