Idiopathic sclerosing encapsulating peritonitis in a young female-diagnosis of abdominal cocoon

Abdominal cocoon is a rare cause of relative external small bowel obstruction. It is diagnosed predominantly in female adolescents. Diagnosis is made incidentally at laparotomy. In the past, most patients originated from subtropical regions. We discussed the first patient to be diagnosed as having the said condition in the Netherlands. A preoperative diagnosis would have been facilitated by previous knowledge of the condition. An adopted female adolescent of subtropical origin presented with recurrent failure of intestinal passage at our pediatric surgery ward after referral. Preoperative workup with a contrast-enhanced small bowel passage study showed a gastric and duodenal distension and a cauliflower sign on late passage films. Explorative laparotomy was performed under suspicion of a proximal jejunal obstruction. Findings at laparotomy were characteristic of abdominal cocoon.