Idiopathic sclerosing encapsulating peritonitis (or abdominal cocoon): a report of 5 cases

Abstract

Sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction that is characterized by a thick grayish-white fibrotic membrane encasing the small bowel. SEP can be classified as idiopathic, also known as abdominal cocoon, or secondary. It is difficult to make a definite pre-operative diagnosis. We experienced five cases of abdominal cocoon, and the case files were reviewed retrospectively for the clinical presentation, operative findings and outcome. All the patients presented with acute, subacute and chronic intestinal obstruction. Computed tomography (CT) showed characteristic findings of small bowel loops congregated to the center of the abdomen encased by a soft-tissue density mantle in four cases. Four cases had an uneventful post-operative period, one case received second adhesiolysis due to persistent ileus. The imaging techniques may facilitate pre-operative diagnosis. Surgery is important in the management of SEP.

Figure 1

Contrast-enhanced abdomen computed tomography (CT) demonstrating characteristic findings of small bowel loops congregated to the center of the abdomen encased by a soft-tissue density mantle (arrow).

Figure 2

Histological examination of membranous tissues shows proliferation of fibroconnective tissues (HE, × 100 ).