Idiopathic sclerosing encapsulating peritonitis (abdominal cocoon): A case series on clinical features, imaging, and surgical outcomes

Abstract

Background: Sclerosing encapsulating peritonitis, also known as abdominal cocoon syndrome, is a rare cause of small bowel obstruction characterized by encasement of the intestines within a fibrocollagenous membrane. Preoperative diagnosis is often challenging due to nonspecific clinical presentation and overlapping imaging features. We present a case series of two male patients who presented with features of acute intestinal obstruction. Both patients had a history of abdominal pain, bilious vomiting, and obstructive symptoms. Contrast-enhanced computed tomography (CECT) revealed cluster of small bowel loops resembling an internal hernia. Intraoperatively, a thick fibrous membrane encasing the small intestine was identified in both cases, pointing to the diagnosis of idiopathic sclerosing encapsulating peritonitis. Both patients underwent surgical management with complete excision of the fibrous membrane and adhesiolysis. One case required extensive dissection due to involvement of the entire small bowel, while the other involved segmental bowel encasement. The postoperative course was uneventful in both cases, with gradual return of bowel function and favourable recovery. This case series highlights the importance of considering abdominal cocoon syndrome as a differential diagnosis in patients presenting with intestinal obstruction. Early recognition and timely surgical intervention are crucial for optimal outcomes.