Idiopathic sclerosing encapsulating peritonitis (abdominal cocoon) presenting with abdominal pain and palpable mass: a case report.

Abstract

Introduction: Sclerosing encapsulating peritonitis (SEP), also known as abdominal cocoon, is a rare condition characterized by a fibrocollagenous membrane encasing the bowel, leading to symptoms ranging from vague abdominal discomfort to intestinal obstruction. It may be primary (idiopathic) or secondary, most commonly associated with prior peritoneal dialysis.

Case presentation: A 45-year-old Ethiopian man presented with acute periumbilical abdominal pain, nausea, and a palpable abdominal mass, with a background of chronic intermittent abdominal symptoms for 5 years. Exploratory laparotomy revealed small bowel loops encased in a thick fibrocollagenous membrane consistent with abdominal cocoon. Complete membrane excision was performed, with preservation of bowel viability. Histopathology confirmed fibrocollagenous tissue with sclerosis and inflammatory infiltrates. The postoperative course was uneventful.

Discussion: The pathogenesis of primary SEP remains unclear but is thought to involve chronic peritoneal inflammation. Due to its nonspecific presentation, diagnosis is often made intraoperatively, particularly in resource-limited settings. Surgical excision of the encapsulating membrane remains the mainstay of treatment.

Conclusion: This case highlights the diagnostic challenges of abdominal cocoon and emphasizes the importance of maintaining a high index of suspicion, especially in patients from resource-limited settings presenting with unexplained intestinal obstruction.

Graphical abstract available at: https://links.lww.com/IJSCR/A143.