Abdominal cocoon syndrome, a rare cause of intestinal obstruction presenting in an Asian adult male: a case report

Abstract

Introduction and Importance: Primary sclerosing encapsulating peritonitis (SEP), commonly known as abdominal cocoon syndrome (ACS), is considered to be one of the rare causes of intestinal obstruction. This syndrome is characterized by the formation of a fibrous-collagenous membrane that encapsulates the intestine and other abdominal organs. Several theories have been proposed to explain the disease’s etiology. Patients often present with symptoms of partial intestinal obstruction, which is challenging to diagnose before laparotomy. Of all the available investigations, the contrast-enhanced computed tomography of the abdomen is the most sensitive, showing a sac-like fibrous membrane covering the bowel loops along with the fluid collection. Definitive treatment includes excision and adhesiolysis. Case Presentation: We present a case report of ACS in a 30-year-old male patient. Clinical Findings and Investigations: The patient presented with a chronic history of progressive colicky abdominal pain associated with nausea, vomiting, constipation, and weight loss. Interventions and Outcome: Multiple investigations, including abdominal X-rays, ultrasound, and upper GI endoscopy, were unremarkable. However, the contrast-enhanced computed tomography abdomen suggested small bowel obstruction with a differential diagnosis of SEP. Later explorative laparotomy and histopathological examination confirmed the diagnosis of ACS. Adhesiolysis was performed intraoperatively, which resolved the patient’s symptoms. The patient was asymptomatic at the 6th month follow-up visit. Relevance and Impact: Being a fairly rare condition, primary SEP can lead to a plethora of misdiagnoses and discomfort to the patient if not diagnosed on time. This case report aims to create awareness of this disease outside of the expected demographics- perimenarchal Asian girls. It is highly important for this unusual case to serve as an educative tool for physicians all over the world.