Abdominal cocoon: a rare cause of acute intestinal obstruction

Sclerosing encapsulating peritonitis (SEP) is a relatively rare cause of intestinal obstruction resulting from encasement of variable lengths of bowel by dense fibro-collagenous membrane. The idiopathic cases of SEP, which lack any identifiable cause from clinical, radiological and histopathological findings, are also reported under the descriptive term “abdominal cocoon syndrome”. Patient with SEP present with intestinal obstruction. Persistent untreated SEP may advance to bowel gangrene or intestinal perforation, which are life threatening conditions. We report the rare occurrence of SEP in a 45-year-old male presenting with signs of intestinal obstruction. Imaging findings revealed abdominal cocoon with bowel gangrene leading to perforation and the same was confirmed at surgery. Surgical excision of the fibrotic sac encasing the bowel, resection of gangrenous bowel segment and end ileostomy were performed. Histopathology of the excised membrane confirmed the diagnosis of SEP. Radiologists should be aware of this relatively rare cause of intestinal obstruction, its imaging findings and complications, as an accurate preoperative diagnosis will prevent diagnostic delay and aid the surgeon in planning treatment.