Encapsulating Peritoneal Sclerosis: A Rare Cause of Acute and Recurrent Abdominal Pain; A Case Report of Abdominal Cocoon Syndrome

Document Type : Case Report

Authors

1 Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

3 Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran

4 Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran

10.30476/acrr.2025.107962.1254

Abstract

Encapsulating peritoneal sclerosis (EPS), also known as abdominal cocoon syndrome, is a rare condition that
may present with abdominal pain or intestinal obstruction due to the encasement of bowel loops within a
fibrocollagenous membrane. We report the case of a 27-year-old woman who presented with severe generalized
abdominal pain, nausea, and vomiting that did not respond to conservative treatment. Physical examination
revealed right lower quadrant tenderness, and subsequent exploratory laparotomy demonstrated abdominal
cocoon syndrome associated with an appendiceal mucocele. This rare entity typically manifests as recurrent
abdominal pain and obstructive symptoms, and while conservative therapy may provide transient relief, it
often delays diagnosis. Surgical excision of the fibrous membrane with adhesionolysis remains the definitive
treatment in severe cases. Abdominal cocoon syndrome should be considered in the differential diagnosis of
unexplained abdominal pain and obstruction, as diagnosis is frequently established only intraoperatively.

Keywords

References

1. Hasan M, Muhsin OMA, Abassi A,
Youssufani R. Abdominal Cocoon: A
report of three cases. Middle East J
Emergency Med. 2007;7(2).
2. Yip FW, Lee S. The abdominal
cocoon. Australian and New Zealand
Journal of Surgery. 1992;62(8):638-42.
3. Owtschinnikow P. Peritonitis chronica
fibrosa incapsulata. Arch Klin Chir.
1907;83:623-34.
4. Solak A, Solak I. Abdominal cocoon
syndrome: preoperative diagnostic
criteria, good clinical outcome with
medical treatment and review of
the literature. Turkish Journal of
Gastroenterology. 2012;23(6):776-9.
5. Jagdale A, Prasla S, Mittal S.
Abdominal cocoon-A rare etiology
of intestinal obstruction. Journal of
Family Medicine and Primary Care.
2017;6(3):674-6.
6. Devay AO, Gomceli I, Korukluoglu B,
Kusdemir A. An unusual and difficult
diagnosis of intestinal obstruction:
The abdominal cocoon. Case report
and review of the literature. World
Journal of Emergency Surgery.
2006;1(1):8.
7. 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.
8. Vagholkar K, Doctor-Ganju
K. Abdominal cocoon: a
surgical challenge. Int Surg J.
2018;5(12):4090-4.
9. Vipudhamorn W, Juthasilaparut T,
Sutharat P, Sanmee S, Supatrakul E.
Abdominal cocoon syndrome-a rare
culprit behind small bowel ischemia
and obstruction: Three case reports.
World Journal of Gastrointestinal
Surgery. 2024;16(3):955.
10. Chien C-Y, Tsai M-T, Chen J-Y,
Chuang C-L, Tian J-Y, Tai H-L, et
al. Encapsulating peritoneal sclerosis
outcomes: a retrospective study on the
significance of nutritional parameter
variations. BMC Nephrology.
2025;26(1):509. doi: 10.1186/
s12882-025-04111-5.
11. Pollock C. Pathogenesis of peritoneal
sclerosis. The International journal
of artificial organs. 2005;28(2):90-6.
12. Al-Lawati AI, Al Shaibi M, Al
Mahruqi G, Augustine T, Moinuddin
Z, Al Hinai M, et al. Encapsulating
Peritoneal Sclerosis: A Case
Report and Literature Review. The
American journal of case reports.
2020;21:e925341. Epub 2020/10/05.
doi: 10.12659/ajcr.925341. PubMed
PMID: 33011732; PubMed Central
PMCID: PMCPMC7545366.
13. Mudarres MF KS, Mudarres F, Khan
Sr S. A Case Report and Clinical
Insights on Encapsulating Peritoneal
Sclerosis: A Rare yet Critical
Complication of Peritoneal Dialysis.
Cureus. 2024;16(8).

Files

Share

How to cite

Statistics