Idiopathic sclerosing encapsulating peritonitis: 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. Preoperative diagnosis requires a high index of clinical suspicion. 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. The radiological diagnosis of abdominal cocoon may now be confidently made on computed tomography scan. 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.

A rare cause of small bowel obstruction

“…Continuous ambulatory peritoneal dialysis treatment is an important risk factor for sclerosing peritonitis. Beta-blockers are also supposed to contribute to the development of secondary sclerosing peritonitis (1). In addition, the disease has been described in association with prior abdominal surgery, subclinical primary viral peritonitis, intestinal transplantation, peritoneal-venous shunting, ventriculoperitoneal shunt, abdominal tuberculosis, and sarcoidosis (1-4).…”

“…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."…”

An unusual cause of vomiting

“…It has also been reported in patients with cirrhosis and abdominal tuberculosis (TB). [1][2][3][4] Inflammation of the peritoneum leads to the formation of a membrane which encases the abdominal viscera, preventing gut motility and causing symptoms of sub-acute bowel obstruction. 2 Clinical examination reveals a tender abdomen and even a palpable mass.…”

“…[1][2][3][4] Inflammation of the peritoneum leads to the formation of a membrane which encases the abdominal viscera, preventing gut motility and causing symptoms of sub-acute bowel obstruction. 2 Clinical examination reveals a tender abdomen and even a palpable mass. 5 Imaging modality of choice is an abdominal CT scan, which is able to demonstrate encased small bowel loops and peritoneal inflammation.…”

Abdominal Cocoon: A Case Series

“…8 Radiological features are non specific but a better awareness of this entity and imaging techniques may facilitate pre-operative diagnosis. 9 Plain and contrast enhanced radiological studies may show incomplete or complete small bowel obstruction, with a circumscribed conglomerated mass of bowel loops with delayed passage of contrast. Only one of our patients had a contrast study suggestive ofa abdominal cocoon.…”