An Unusual Cause of Intestinal Obstruction: 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. 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. 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. Here a case of abdominal cocoon in a 45 years old male is presented due to its rarity and difficulty in preoperative diagnosis.

Abdominal Cocoon: An Unusual Cause of Intestinal Obstruction

“…X-ray abdomen may show small bowel loops enclosed in cocoon of peritoneum causing proximal bowel dilatation or dilated bowel loop lying in a concertina fashion giving cauliflower sign. 9 CT scan remains the gold standard in diagnosis of abdominal cocoon. It demonstrates thickened membrane encasing small bowel loops, thickened bowel loops, tethering or matting of bowel or peritoneal calcification.…”

A rare cause of small bowel obstruction

“…Diagnosis depends on clinical suspicion and imaging modalities. Barium studies may reveal a circumscribed mass of bowel loops conglomerated in one area with delayed small bowel transit time (1,2). Along with appropriate clinical setting, oral and intravenous contrast enhanced computed tomography (CT) of the abdomen which shows dilated small bowel within a thick membrane, as though it were in a cocoon, is diagnostic of "sclerosing encapsulating peritonitis."…”

CT and MRI findings of abdominal cocoon without intestinal obstruction

“…Aynı zamanda skleroze enkapsüle peritonit (SEP) olarak da isimlendirilmektedir. Nadir görülen bir tablodur ve ilk kez Foo tarafından 1978 yılında tanımlanmıştır 2,3 . İntestinal tıkanıklığın nadir bir nedenidir ve kesin tanı laparotomi ile konur, ancak preoperatif tanı da mümkündür.…”