Tapan Mukherjee1

INTRODUCTION: Abdominal Cocoon also known as Sclerosing encapsulating peritonitis is a rare condition that refers to total or partial encapsulation of the small bowel by a fibrocollagenous membrane or cocoon with local inflammatory infiltrate leading to acute or chronic bowel obstruction

BACKGROUND: The abdominal cocoon is a rare cause of intestinal obstruction and is usually diagnosed at the time of laparotomy, although bowel obstruction with abdominal lump should raise a suspicion. The aetiology is usually of unknown, although at times, it may be seen secondary to a variety of conditions. Approximately 60 cases have been reported in the literature. Tuberculosis is an infrequently implicated cause of abdominal cocoon, and has only occasionally been reported previously in the Literature, but its significance is more in India and places where the disease is more prevalent.

MATERIALS & METHODS: The author encountered four cases of abdominal cocoon all diagnosed on laparotomy. They have been studied for the patient particulars, clinical presentation, operative findings and outcome.

RESULT: All four patients presented with history suggestive of varying degrees of intestinal obstruction of variable duration. There was no history or findings to suggest a specific cause. The diagnosis of abdominal cocoon was never entertained pre-operatively in any, and they were all operated upon as cases of intestine al obstruction. The operative findings were similar in all cases, a large part of jejuno-ileum being encased amidst dense adhesion in a tough and smooth walled thick capsule. As a rule, there were dense inter-loop bowel adhesions in all the cases. All required surgical release of encapsulated loops of bowel (adhesiolysis). All recovered well after minor hiccups and attended follow up. Histopathological examination of the cocoon wall revealed in all cases more or less same picture: proliferation of fibrocollagenous tissue with non-specific chronic inflammatory reaction and with non-caseating epithelioid cell granulomas without Langhans' type of giant cells. AFB could never be found.

CONCLUSION: Abdominal Cocoon is a rare clinical entity presenting as intestinal obstruction and is probably due to recurrent low grade or subclinical peritonitis, during which the patients had no significant abdominal signs, leading to sclerosis and membrane formation with subsequent development of a cocoon. Tuberculosis is highly prevalent in this part of the world and is likely to have a role.