Idiopathic sclerosing encapsulating peritonitis: abdominal cocoon

Abstract

Abdominal cocoon, the idiopathic form of sclerosing encapsulating peritonitis, is a rare condition of unknown etiology that results in an intestinal obstruction due to total or partial encapsulation of the small bowel by a fibrocollagenous membrane. Preoperative diagnosis requires a high index of clinical suspicion. The early clinical features are nonspecific, are often not recognized and it is difficult to make a definite pre-operative diagnosis. Clinical suspicion may be generated by the recurrent episodes of small intestinal obstruction combined with relevant imaging findings and lack of other plausible etiologies. The radiological diagnosis of abdominal cocoon may now be confidently made on computed tomography scan. Surgery is important in the management of this disease. Careful dissection and excision of the thick sac with the release of the small intestine leads to complete recovery in the vast majority of cases.

Keywords: Computed tomography scan; Encapsulate; Intestinal obstruction; Peritonitis; Sclerosis; Surgery.

Figure 1

Computed tomography scan. A: Axial contrast enhanced computed tomography (CT) scan of the abdomen showing bowel loop mass encased in a membrane; B: Anterio-posterior CT scan of the abdomen showing thin membrane around bowel loops.

Figure 2

Laparotomy showing an encapsulating thick, white adherent membrane encasing the small bowel.