Successful laparoscopic management of idiopathic sclerosing encapsulating peritonitis: a case report

Idiopathic sclerosing encapsulating peritonitis (SEP), also termed "abdominal cocoon syndrome," is an extremely rare cause of intestinal obstruction characterized by the encasement of small-bowel loops within a fibrous membrane. Although SEP has traditionally been treated by laparotomy, laparoscopy has emerged as a safe alternative when feasible.

We describe a 32-year-old man with no significant past medical history who presented with acute abdominal pain and vomiting. An abdominal computed tomography (CT) scan demonstrated clustered ileal loops enveloped by a dense capsule, suggestive of SEP. Emergency laparoscopic surgery was performed, confirming a thick fibrous membrane surrounding the distal ileum. Careful adhesiolysis and excision of the capsule were achieved without bowel resection. The patient recovered uneventfully and was discharged on the second postoperative day.

SEP is categorized as primary (idiopathic) or secondary. Idiopathic SEP remains exceedingly rare. Diagnosis is challenging preoperatively due to nonspecific clinical features, but CT findings may suggest the characteristic "cocoon sign." Surgery remains the mainstay of treatment, consisting of adhesiolysis and excision of the encapsulating membrane. Conservative management can be considered as the initial approach in patients presenting without signs of severity. Emerging reports support laparoscopy as a viable alternative to laparotomy, offering faster recovery and lower morbidity.

This case illustrates the feasibility and safety of laparoscopic management of idiopathic SEP. Minimally invasive surgery should be considered whenever expertise is available, as it provides effective treatment with reduced morbidity.