Abdominal Cocoon or Encapsulating Peritoneal Sclerosis: A Rare Cause of Small Bowel Obstruction
  • Omar Lasheen
    General Surgery Department, Royal Oldham Hospital, Pennine Acute Trust, Manchester, UK
  • Mohamed ElKorety
    General Surgery Department, West Hertfordshire Hospitals NHS Trust, Hertfordshire, UK


Encapsulating peritoneal sclerosis, sclerosing encapsulating peritonitis, bowel obstruction, intestinal obstruction, abdominal cocoon syndrome


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.



  • Solak A, Solak I. Abdominal cocoon syndrome: preoperative diagnostic criteria, good clinical outcome with medical treatment and review of the literature. Turk J Gastroenterol 2012;23(6):776–779.
  • Habeeb MA, Vishwakarma SK, Abdul Wajid M, Bardia A, Khan AA, Bheerappa N. Abdominal cocoon: an enigma. Trop Gastroenterol 2015;36(2):130–131.
  • Gurleyik G, Emir S, Saglam A. The abdominal cocoon: a rare cause of intestinal obstruction. Acta Chir Belg 2010;110(3):396–398.
  • Singhal M, Krishna S, Lal A, Narayanasamy S, Bal A, Yadav TD, et al. Encapsulating peritoneal sclerosis: the abdominal cocoon. Radiographics 2019;39(1):62–77.
  • Mohakud S, Juneja A, Lal H. Abdominal cocoon: preoperative diagnosis on CT. BMJ Case Rep 2019;12(5):10–12.
  • Arif SH, Mohammed AA. Abdomen cocoon causing chronic abdominal pain and intestinal obstruction; a case series. Ann Med Surg 2019;48:7–10.
  • Deutsch GB, Shamonki J, Bilchik AJ. The cocoon abdomen. JAMA Surg 2014;149(11):1201–1202.
  • Xia J, Xie W, Chen L, Liu D. Abdominal cocoon with early postoperative small bowel obstruction: a case report and review of literature in China. Medicine (Baltimore) 2018;97(25):e11102.
  • Gorsi U, Gupta P, Mandavdhare HS, Singh H, Dutta U, Sharma V. The use of computed tomography in the diagnosis of abdominal cocoon. Clin Imaging 2018;50(2017):171–174.
  • Sharma V, Singh H, Mandavdhare HS. Tubercular abdominal cocoon: systematic review of an uncommon form of tuberculosis. Surg Infect (Larchmt) 2017;18(6):736–741.
  • Views: 792
    HTML downloads: 151
    PDF downloads: 446

    Published: 2020-10-12
    Issue: 2020: Vol 7 No 12 (view)

    How to cite:
    Lasheen O, ElKorety M. Abdominal Cocoon or Encapsulating Peritoneal Sclerosis: A Rare Cause of Small Bowel Obstruction. EJCRIM 2020;7 doi:10.12890/2020_001972.