Sclerosing peritonitis presenting as complete mechanical bowel obstruction: a case report

Abstract

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.

Abdominal cocoon syndrome: Rare cause of intestinal obstruction—Case report and systematic review of literature

“…As a result, 97 articles were included in our study. [3–41] The flow diagram of the study is shown in Figure 4. These articles were carefully studied, and a database with the patients’ characteristics was made, which could be available if requested.…”

Acute presentation of cocoon abdomen as septic peritonitis mimicking with strangulated internal herniation: a case report

“…In most cases the cause of sclerosing peritonitis is unknown. However, patients on long-standing peritoneal dialysis, with peritoneal shunts, and those suffering from abdominal tuberculosis are more prone to develop this fibrous layer around the bowel [ 6 ]. The prevalence of abdominal cocoon syndrome (ACS) is unknown, but among peritoneal dialysis patients, the prevalence is 1.4–7.3% [ 7 ].…”

Case report of a rare cause of intestinal obstruction: Abdominal cocoon syndrome

“…Inflammatory cells are always present, but leukocyte infiltration is not a must for diagnosis [14]. In the pathogenesis of cocoon formation, It is thought that fibrogenic cytokines are released from fibroblasts trigger neoangiogenesis and peritoneal fibrosis [15,16].…”