Abdominal cocoon syndrome presenting with high-grade small bowel obstruction and postoperative intra-abdominal collection: a case report from Saudi Arabia

Abdominal cocoon syndrome, also called idiopathic sclerosing-encapsulating peritonitis, is a rare cause of intestinal obstruction in which bowel loops are enclosed by a fibrocollagenous membrane. Diagnosis is often delayed because symptoms are nonspecific and many cases are confirmed only at operation. We report a case of a 65-year-old man in Saudi Arabia who presented with vomiting, abdominal distension, anorexia, constipation, and colicky epigastric and periumbilical pain. Computed tomography showed high-grade small bowel obstruction at the distal ileum with features of encapsulating peritoneal sclerosis. Diagnostic laparoscopy was converted to open laparotomy because of complex adhesions and a mass involving the distal ileum, right colon, sigmoid colon, and bladder. He underwent adhesiolysis, right hemicolectomy, and ileocolic anastomosis. Recovery was complicated by intra-abdominal collections requiring image guided drainage. He recovered clinically and remained well at follow-up.