A Rare Case of Recurrent Intestinal Obstruction in a Young Female: Abdominal Cocoon

Abdominal cocoon syndrome (ACS), also known as sclerosing encapsulating peritonitis (SEP), is an uncommon cause of intestinal obstruction characterized by partial or total encapsulation of the small intestine by a fibrous membrane. It typically presents with recurrent or subacute episodes of bowel obstruction and is often diagnosed intraoperatively due to the non-specific nature of clinical and radiologic findings. A 17-year-old girl presented with symptoms of acute intestinal obstruction, including abdominal pain, vomiting, and obstipation. She had experienced similar episodes over the past year. Initial investigations were inconclusive, and though emergency laparotomy was considered, her symptoms transiently improved. Thus, an elective diagnostic laparoscopy was later performed, revealing the presence of an encapsulating fibrous membrane consistent with ACS. The membrane was dissected and removed. Histopathology showed fibrocollagenous tissue with inflammation but no granuloma or malignancy. The patient recovered well postoperatively, with a one-month follow-up uneventful. ACS remains a diagnostic challenge due to its rarity and non-specific presentation. Laparoscopic intervention serves as both a diagnostic and therapeutic tool, particularly in young patients with recurrent, unexplained episodes of obstruction.