Sclerosing encapsulating peritonitis (Abdominal Cocoon) associated with Non-Hodgkin's lymphoma of bowel wall: a rare...

Sclerosing encapsulating peritonitis (SEP) is a rare condition causing intestinal obstruction. A thick fibrous membrane envelops abdominal organs. SEP is classified into two types: abdominal cocoon syndrome (ACS), also called idiopathic or primary SEP, and secondary SEP. Symptoms range from subacute to acute intestinal blockage, and diagnosis is usually confirmed during laparotomy.

The authors present a case of a 32-year-old woman who presented with intermittent per-vaginal bleeding for 1 month, abdominal distension, decreased appetite, and significant weight loss over 5 months. Examination revealed pallor and a palpable 12×12 cm mass in the right lower abdomen. Imaging revealed a lobulated mass in the mid-ileum with bowel wall thickening. She underwent laparotomy, revealing fibrous tissue, and a nodular mass on the distal ileum. Histopathology confirmed non-Hodgkin's lymphoma.

Sclerosing encapsulating peritonitis is a rare chronic inflammatory condition affecting the peritoneum. Primary SEP, also known as abdominal cocoon or idiopathic SEP, lacks a definitive cause, while secondary SEP results from conditions like peritoneal dialysis, liver cirrhosis, and malignancies. It involves peritoneal irritation leading to inflammation, fibrin-like material release, and subsequent bowel encasement and fibrosis. Diagnosis is typically made during laparotomy, though contrast-enhanced CT scan aids in presumptive diagnosis.

This case report highlights a rare occurrence of abdominal cocoon syndrome in a patient with non-Hodgkin B-cell lymphoma, presenting with abdominal pain, distension, and bowel obstruction. Diagnosing this condition early is crucial, especially in patients with underlying malignancies. More research is needed to improve management.