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Open Access Highly Accessed Case report

Idiopathic sclerosing encapsulating peritonitis (or abdominal cocoon)

Costas Serafimidis1*, Ioannis Katsarolis2, Spyros Vernadakis1, George Rallis1, George Giannopoulos1, Nikolaos Legakis1 and George Peros1

Author affiliations

1 4th Department of Surgery, ATTIKON University General Hospital, Athens Greece, 1 Rimini Avenue, 12462 Haidari, Athens Greece

2 4th Department of Internal Medicine, ATTIKON University General Hospital, Athens Greece, 1 Rimini Avenue, 12462 Haidari, Athens Greece

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Citation and License

BMC Surgery 2006, 6:3  doi:10.1186/1471-2482-6-3

Published: 13 February 2006

Abstract

Background

Idiopathic sclerosing encapsulating peritonitis (or abdominal cocoon) is a rare cause of small bowel obstruction, especially in adult population. Diagnosis is usually incidental at laparotomy. We discuss one such rare case, outlining the fact that an intra-operative surprise diagnosis could have been facilitated by previous investigations.

Case presentation

A 56 year-old man presented in A&E department with small bowel ileus. He had a history of 6 similar episodes of small bowel obstruction in the past 4 years, which resolved with conservative treatment. Pre-operative work-up did not reveal any specific etiology. At laparotomy, a fibrous capsule was revealed, in which small bowel loops were encased, with the presence of interloop adhesions. A diagnosis of abdominal cocoon was established and extensive adhesiolysis was performed. The patient had an uneventful recovery and follow-up.

Conclusion

Idiopathic sclerosing encapsulating peritonitis, although rare, may be the cause of a common surgical emergency such as small bowel ileus, especially in cases with attacks of non-strangulating obstruction in the same individual. A high index of clinical suspicion may be generated by the recurrent character of small bowel ileus combined with relevant imaging findings and lack of other plausible etiologies. Clinicians must rigorously pursue a preoperative diagnosis, as it may prevent a "surprise" upon laparotomy and result in proper management.