Abdominal Cocoon - A Rare Presentation of Intestinal Obstruction

Sclerosing encapsulating peritonitis is rare and unusual presentation of small bowel obstruction.1In 1907, Owtschinnikow observed it and he named it as peritonitis chronic afibrosa incapsulata.2,3,4,5It is characterized by dense fibrocollagenous sheet that encases whole or a part of small intestine.3It is categorized into two main classes primary and secondary.6Causes of secondary form are peritoneal dialysis, pelvic inflammatory disease, disseminated tuberculosis and sarcoidosis.6 Its idiopathic or primary form also known as idiopathic sclerosing encapsulating peritonitis or abdominal cocoon.7Its etiology is still unknown. It manifests itself in three inflammatory processes, i.e., recurrent acute, sub-acute, chronic.8On basis of routine investigation it is difficult to make diagnosis . Mostly it is diagnosed intraoperatively.9,10With advancement of imaging modalities like computed tomography,its diagnosis can be made.11But still surgery remains at top of it management strategy and it is mainstay of treatment12