Cocoon abdomen - A rare cause of intestinal obstruction

Sclerosing encapsulating peritonitis or abdominal cocoon is a rare condition of unknown etiology in which intestinal obstruction result from encasement of variable length of bowel by dense fibro collagenous membrane.

A case of young male is reported who presented with features of small bowel obstruction with tender mass in the right iliac fossa. CT scan suggested features of internal herniation. On exploration, he was found to have small intestine, large intestine, stomach and liver covered with a thick cocoon like membrane. The membrane was gently peeled off the small intestine. The patient recovered well and was discharged on an oral diet.

Preoperative diagnosis of abdominal cocoon is difficult and most cases are discovered incidentally on laparotomy. Contrast enhanced computed tomography or barium meal may be helpful in preoperative diagnosis. Surgical treatment is the main stay of treatment for this condition. Simple removal of the membrane and lysis of the adhesions produces optimal outcome. Bowel resection is indicated only when the intestine is nonviable.

A high index of suspicion and appropriate radiology can prevent 'surprises' and unnecessary bowel resection. Simple removal of the membrane gives a good outcome.