Abdominal cocoon: A rare cause of intestinal obstruction

Asem Ghasoup, MD, FACS, Ishaq Mudawi, MD, Ayman Al Tahan, MD, Mohammed Widinly, MD, MRCS. Security Forces Hospital Makkah

INTRODUCTION: Abdominal cocoon syndrome or peritonitis chronica fibrosaincapsulata’ is a rare condition that refers to total or partial encapsulation of the small bowel by a fibro-collagenous membrane with local inflammatory infiltrate leading to acute or chronic bowel obstruction.

PRESENTATION OF CASE: A 37years old male presented with sub-acute intestinal obstruction. Intra-operatively, the entire small bowel was found to be encapsulated in a dense fibrous sac. The peritoneal sac was excised, followed by lysis of the inter-loop adhesions. Postoperative recovery was unremarkable.

DISCUSSION: Most patients with abdominal cocoon syndrome present with features of recurrent acute or chronic small bowel obstruction secondary to kinking and/or compression of the intestines within the constricting cocoon. An abdominal mass may also be present due to an encapsulated cluster of dilated small bowel loops.

CONCLUSION: Abdominal cocoon is a rare condition causing intestinal obstruction and diagnosis requires a high index of suspicion because of the nonspecific clinical picture. CT Scan of the abdomen is a useful radiological tool to aid in preoperative diagnosis. Peritoneal sac excision and adhesiolysis is the treatment of choice  and the outcome is usually satisfactory.

Keywords: Sclerosing encapsulating peritonitis, Subacute intestinal obstruction