Introduction Sclerosing peritonitis or abdominal cocoon syndrome is characterized by small bowel loops completely encapsulated by a fibrocollagenous membrane in the center of the abdomen. Although cocooning of the abdomen is mostly seen in patients on peritoneal dialysis, it can occur de novo; it very rarely manifests as complete mechanical bowel obstruction. Case presentation A 46-year-old Asian man presented with complete mechanical bowel obstruction. He had previous attacks of partial bowel obstruction during the past 6 to 8 months, which was misdiagnosed as abdominal tuberculosis because tuberculosis is very prevalent in the region in which he lives. He took anti-tuberculosis therapy for 3 months but this did not result in resolution of his symptoms. This time he had diagnostic laparoscopy followed by laparotomy in which a fibrocollagenous membrane, resulting in entrapment of his bowel, was excised and his entire small bowel was freed. Postoperatively he again had a mild episode of partial bowel obstruction but this was relieved with a short course of steroids. Discussion Sclerosing peritonitis is a rare benign etiology of complete mechanical bowel obstruction. Patients might have suffered recurrent attacks of partial bowel obstruction in the past that were falsely managed on lines of other conditions such as tuberculosis, especially in endemic areas like Pakistan or India. Conclusion Sclerosing peritonitis is a rare benign diagnosis which can manifest as complete bowel obstruction and a high index of suspicion is required to diagnose it. Contrast-enhanced computed tomography of the abdomen is a useful radiological tool to aid in preoperative diagnosis. Diagnostic laparoscopy is usually confirmatory. Peritoneal sac excision and adhesiolysis is the treatment and a short course of steroids in relapsing symptoms.

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Incidental gallbladder carcinoma (IGBC) is an incidental finding of cancer on histopathological examination (HPE) of gall bladder specimen removed for benign gall bladder diseases. The incidence of IGBC ranges from 0.19e3.3%. However, many such tumours are of advanced T stage on HPE. Some of these tumors are possibly missed on either pre-operative evaluation and/or during cholecystectomy. This study was done to find the proportion of patients of IGBC who had preoperative and/or intra-operative suspicious of GBC but underwent simple cholecystectomy. Materials and methods: Data from 56 consecutive IGBC patients presented to our centre between April 2016eMay 2017 was analysed. A review of preoperative imaging and operative notes was done to ascertain any suspicion of malignancy-in-retrospect. Results: Preoperative USG was suspicious in 39% (22/56) of patients. CECT scan done in 13 of these patients confirmed gallbladder wall abnormalities in 10 cases. Majority of procedures were open cholecystectomy (39/56), suspicious intraoperative findings were documented in 15 (26.7%) patients. Time to referral after primary surgery was within one month in 30.3% (17/56), between one to two months in 35.7% (20/56), between 2 and six months in 23.3% (13/56) and after six months in 10.7% (6/56). Seventeen patients (30.3%) were advised completion surgery. Seven patients (13%) underwent completion surgery. Rest of the patients were found to be inoperable. Conclusion: Radiologists and surgeons should keep a high index of suspicion of GBC, especially in high incidence areas. Whenever, there is any suspicion, patients should be promptly referred appropriately. Even when detected incidentally, prompt referral maximises chances of curative resection.

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