Abdominal cocoon syndrome (idiopathic sclerosing encapsulating peritonitis): An extremely rare cause of small bowel obstruction—Two case reports and a review of literature

Abstract

IntroductionSclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction in which the bowel and internal abdominal organs are wrapped with a fibrocollagenous cocoon-like encapsulating membrane [1,2]. SEP is divided into two entities: abdominal cocoons (AC), also known as idiopathic or primary sclerosing encapsulating peritonitis, which is of extremely rare type, and secondary sclerosing encapsulating peritonitis, which is the more common type.Case presentationTwo male patients from India, a 26 year old and a 36 year old, presented to our hospital complaining about abdominal pain associated with nausea and vomiting without any history of previous surgical interventions; the patients' vitals were stable. Preoperative diagnosis of abdominal cocoon was established by abdominal computed tomography. It showed multiple dilated fluid-filled small bowel loops in the center of the abdominal cavity with thin soft tissue, non-enhancing capsules encasing the small bowel loops with mesenteric congestion involving small and large bowel loops. Both patients underwent complete surgical excision of the sac without intraoperative complications. Patients had a smooth postoperative hospital course and were discharged home in good conditions.ConclusionPatients with abdominal cocoons have a non-specific clinical presentation of intestinal obstruction. A high index of clinical suspicion in combination with the appropriate radiological investigation will increase the chance of preoperative detection of the abdominal cocoon. In patients with complete bowel obstruction, complete excision of the peritoneal sac is the standard of care.

Chronic constipation and acute small bowel obstruction due to small bowel encapsulation: A case report

“…The underlying cause of this condition included viral infection, retrograde menstruation, and pelvic inflammatory disease (PID). 8,11 This theory cannot justify the male dominance of AC. 11 SEP is also an acquired condition that mainly occurs in peritoneal dialysis patients.…”

“…Like CPE, the etiology and pathogenesis are poorly understood, but the theory that subclinical peritonitis developed to AC generally agrees. The underlying cause of this condition included viral infection, retrograde menstruation, and pelvic inflammatory disease (PID) 8,11 . This theory cannot justify the male dominance of AC 11 …”

“…The primary etiologies of both syndromes are idiopathic, and the second one is related to chronic peritoneal dialysis. 8 All of these conditions are usually accidentally diagnosed during surgery or autopsy. Otherwise, some cases became symptomatic.…”

“…Other syndromes with small bowel encapsulation are abdominal cocoon syndrome (ACS) and sclerosing encapsulating peritonitis (SEP). The primary etiologies of both syndromes are idiopathic, and the second one is related to chronic peritoneal dialysis 8 …”

Abdominal cocoon syndrome, a diagnostic challenge affecting the treatment. A rare case report from Somalia

“…Peritoneal encapsulation (PE) is a congenital abnormality, in which part or all of the small intestine is covered with a thin peritoneal membrane and without intestinal adhesions and rarely characterises by intestinal obstruction [ 2 , 3 ].…”