Unraveling the cocoon: A case report on preoperative ambiguity and definitive surgical management of encapsulating peritoneal sclerosis
Year: 2025
Type: article
Study design: Case Report
Abstract: INTRODUCTION: Abdominal cocoon, or sclerosing encapsulating peritonitis (SEP), is a rare condition characterized by a fibrocollagenous membrane encasing the intestines, often leading to obstruction. First described in 1907, its etiology remains unclear, with primary (idiopathic) and secondary forms linked to prior surgeries, infections, or systemic diseases. Preoperative diagnosis remains challenging due to nonspecific symptoms. CASE PRESENTATION: A 49-year-old female presented with abdominal pain, vomiting, and constipation. Imaging revealed dilated bowel loops and adhesions. Exploratory laparotomy confirmed SEP, with histopathology showing chronic active colitis and fibrous peritoneum. Adhesiolysis and loop ileostomy were performed, with the patient discharged in stable condition. DISCUSSION: SEP is classified into three anatomical types, with idiopathic cases often lacking identifiable risk factors. Diagnostic imaging (CT/MRI) aids suspicion, but definitive diagnosis typically requires laparotomy. The condition must be differentiated from peritoneal encapsulation, a distinct entity. Management depends on severity, ranging from membrane excision to bowel resection. A review of 14 published cases highlights laparotomy as the gold standard for both diagnosis and treatment, though laparoscopic approaches are emerging. CONCLUSION: SEP remains a diagnostic dilemma, necessitating high clinical suspicion in cases of unexplained obstruction. Surgical intervention is often curative, but meticulous technique is vital to avoid complications. Further research into biomarkers and minimally invasive diagnostic tools is warranted.
Authors: Suman Khadka, Diwakar Koirala, Ramesh Sapkota, Tek Nath Yogi, Kriti Basnet, Vijay Shrestha
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,090
OpenAlex ID: W4415223977