title: Idiopathic sclerosing encapsulating peritonitis (abdominal cocoon) in adult male. A case report.
abstract: BACKGROUND
  Abdominal cocoon (sclerosing encapsulating peritonitis) (SEP) is a rare condition, mostly affecting adolescent girls living in tropical/subtropical region. Its etiology is unknown. It may cause acute or sub-acute intestinal obstruction.
  
  
  METHODS
  We report here a 39 year old male who complained of long standing colicky abdominal pain, with significant weight loss. Abdomen CT scan showed clumping of ileal loops at the level of umbilicus, with a thin capsule surrounding it. Laparoscopy revealed abdominal cocoon, biopsy of which showed dense hypocellular fibro-collagenous tissue with no neoplastic or granulomatous process. Excision of fibrous tissue and release of adhesions was done. Patient was symptoms free after five months follow up.
  
  
  CONCLUSIONS
  Abdominal exploration is usually needed for the diagnosis and treatment of abdominal cocoon. A thick fibrotic peritoneal wrapping of the bowel is usually found. Complete recovery is the result in majority of cases after surgical removal of the wrap causing the cocoon.
  
  
  CONCLUSIONS
  Primary sclerosing encapsulating peritonitis (cocoon abdomen) diagnosis needs a high index of suspicion, as signs and symptoms are nonspecific and imaging findings are not always conclusive. Careful excision of the accessory peritoneal sac and lysis of adhesions between bowels is the best treatment. Prognosis is generally good.
authors.affiliation: Department of General Surgery, Bahrain Specialist Hospital, Manama, Bahrain. Electronic address: ameralqadi2002@yahoo.com.
authors.forename: Amer Hashim
authors.initials: AH
authors.lastname: Al Ani
authors.affiliation: Department of Gastroenterology and Hepatology, Bahrain Specialist Hospital, Manama, Bahrain.
authors.forename: Najah
authors.initials: N
authors.lastname: Al Zayani
authors.affiliation: Department of Gastroenterology and Hepatology, Bahrain Specialist Hospital, Manama, Bahrain.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Najmeddine
authors.affiliation: Department of Pathology, Bahrain Specialist Hospital, Manama, Bahrain.
authors.forename: Sunitha
authors.initials: S
authors.lastname: Jacob
authors.affiliation: Department of Diagnostic Radiology, Bahrain Specialist Hospital, Manama, Bahrain.
authors.forename: Sunil
authors.initials: S
authors.lastname: Nair
keywords: Abdominal cocoon; Encapsulating peritonitis; Idiopathic; Sclerosing