Idiopathic sclerosing encapsulating peritonitis presenting as chronic vomiting and small bowel obstruction: a case report
- 1Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
Introduction:: Idiopathic sclerosing encapsulating peritonitis (SEP), or abdominal cocoon syndrome, is a rare cause of chronic small bowel obstruction characterized by encasement of the small intestine within a fibrocollagenous membrane. Its nonspecific presentation and variable imaging findings frequently make preoperative diagnosis difficult.
Case presentation:: A 39-year-old man presented with several months of progressive intolerance to solid food, recurrent vomiting, abdominal pain, constipation, and weight loss. He had no history of abdominal surgery, tuberculosis, inflammatory bowel disease, peritoneal dialysis, or recurrent peritonitis. Laboratory evaluation showed mild normocytic anemia and hypokalemia. Upper gastrointestinal endoscopy demonstrated mild chronic Helicobacter pylori gastritis without mechanical obstruction. A repeat contrast-enhanced computed tomography scan showed diffuse gastric and small bowel dilatation with delayed transit but no definite transition point or visible encapsulating membrane. Because symptoms persisted despite conservative management, diagnostic laparoscopy was performed and was converted to laparotomy because of extensive adhesions. The entire small intestine was enclosed within a dense fibrocollagenous membrane. Complete membrane excision and adhesiolysis were performed without bowel resection. Histopathology confirmed SEP and showed no evidence of tuberculosis or malignancy. Chronic opium use may have contributed to gastrointestinal dysmotility but could not explain the structural encapsulation. The patient remained symptom-free for 6 months of follow-up.
Conclusion:: Idiopathic SEP should be considered in patients with chronic or recurrent obstructive symptoms despite nondiagnostic imaging. Definitive diagnosis may require operative exploration and histopathological examination.
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BibTeX
@article{asil2026idiopathic,
title = {{Idiopathic sclerosing encapsulating peritonitis presenting as chronic vomiting and small bowel obstruction: a case report}},
author = {Roozbeh Shadidi Asil and Delaram Mousavi and Seyed Mahdi Tabatabaei Naeini and Milad Dodangeh},
journal = {International Journal of Surgery Case Reports},
year = {2026},
month = sep,
doi = {10.1097/rc9.0000000000001057},
url = {https://doi.org/10.1097/rc9.0000000000001057},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Idiopathic sclerosing encapsulating peritonitis presenting as chronic vomiting and small bowel obstruction: a case report
AU - Roozbeh Shadidi Asil
AU - Delaram Mousavi
AU - Seyed Mahdi Tabatabaei Naeini
AU - Milad Dodangeh
PY - 2026
DA - 2026/09/29
JO - International Journal of Surgery Case Reports
DO - 10.1097/rc9.0000000000001057
UR - https://doi.org/10.1097/rc9.0000000000001057
AB - Introduction:: Idiopathic sclerosing encapsulating peritonitis (SEP), or abdominal cocoon syndrome, is a rare cause of chronic small bowel obstruction characterized by encasement of the small intestine within a fibrocollagenous membrane. Its nonspecific presentation and variable imaging findings frequently make preoperative diagnosis difficult. Case presentation:: A 39-year-old man presented with several months of progressive intolerance to solid food, recurrent vomiting, abdominal pain, constipation, and weight loss. He had no history of abdominal surgery, tuberculosis, inflammatory bowel disease, peritoneal dialysis, or recurrent peritonitis. Laboratory evaluation showed mild normocytic anemia and hypokalemia. Upper gastrointestinal endoscopy demonstrated mild chronic Helicobacter pylori gastritis without mechanical obstruction. A repeat contrast-enhanced computed tomography scan showed diffuse gastric and small bowel dilatation with delayed transit but no definite transition point or visible encapsulating membrane. Because symptoms persisted despite conservative management, diagnostic laparoscopy was performed and was converted to laparotomy because of extensive adhesions. The entire small intestine was enclosed within a dense fibrocollagenous membrane. Complete membrane excision and adhesiolysis were performed without bowel resection. Histopathology confirmed SEP and showed no evidence of tuberculosis or malignancy. Chronic opium use may have contributed to gastrointestinal dysmotility but could not explain the structural encapsulation. The patient remained symptom-free for 6 months of follow-up. Conclusion:: Idiopathic SEP should be considered in patients with chronic or recurrent obstructive symptoms despite nondiagnostic imaging. Definitive diagnosis may require operative exploration and histopathological examination.
SN - 2210-2612
ER -