Cocoon Syndrome (Primary Encapsulating Peritonitis): A Rare Cause of Mechanical Intestinal Obstruction

Abstract

Cocoon syndrome, or primary encapsulating peritonitis, is a rare cause of small bowel obstruction belonging to the spectrum of mechanical intestinal obstruction. It is characterized by a thick fibro-collagenous membrane that partially or completely encases the small intestine, leading to impaired bowel motility and obstruction. Clinical presentation is nonspecific and may include nausea, vomiting, abdominal distension, constipation, and features of subacute or acute intestinal obstruction. The condition can occur at any age, and its etiology remains unclear, although it is thought to be either idiopathic or secondary to chronic inflammatory processes within the peritoneal cavity. Diagnosis is primarily radiological, with abdominal CT scan playing a key role in identifying the characteristic clustering of small bowel loops encased within a sac-like membrane. Surgical management is the treatment of choice and consists of careful excision of the fibrous membrane, with or without adhesiolysis, depending on intraoperative findings. In this context, we report the case of a 42-year-old male patient who presented with signs of intestinal obstruction. Abdominal CT imaging was suggestive of cocoon syndrome. The patient underwent exploratory laparotomy, during which a dense fibrous membrane encasing the small bowel was identified and completely excised. The postoperative course was uneventful, with favorable clinical recovery.