Abdominal Cocoon or Encapsulating Peritoneal Sclerosis: A Rare Cause of Small Bowel Obstruction

Encapsulating peritoneal sclerosis (EPS), also known as abdominal cocoon syndrome (AC) or sclerosing encapsulating peritonitis (SEP), is an uncommon condition typically presenting with features of bowel obstruction. We present the case of a 41-year-old male patient who presented to the accident and emergency department with a 7-day history of abdominal pain. Contrast CT of the abdomen and pelvis was ordered and was suggestive of small bowel obstruction involving most of the small bowel with no apparent transition point. Laparotomy showed a tough whitish fibrous membrane encasing the entire length of the small bowel. Advances in CT have made diagnosis possible before a decision on surgical intervention is made. LEARNING POINTS: Despite being a rare cause of bowel obstruction, based on the clinical presentation and CT findings, abdominal cocoon syndrome should be included in the differential diagnosis. CT of the abdomen is the investigation of choice for most cases of bowel obstruction and can be very helpful in reaching a diagnosis before operative management is undertaken. Laparotomy is the usual choice for management, but laparoscopy can be considered either to establish the diagnosis or to deal with the abdominal cocoon based on the surgeon’s clinical judgement and experience.