Surgical Management of Abdominal Cocoon Syndrome

Abdominal cocoon syndrome is a rare form of sclerosing encapsulating peritonitis in which loops of small bowel become encased within a dense fibrocollagenous membrane, leading to chronic or acute intestinal obstruction. Patients typically present with recurrent abdominal pain, distension and vomiting, and diagnosis is often established intraoperatively or, increasingly, by characteristic radiological signs on contrast-enhanced computed tomography. The cornerstone of management is prompt surgical intervention in patients who fail conservative measures. The standard operative approach involves careful excision of the fibrous sac combined with adhesiolysis to release entrapped bowel loops while preserving intestinal viability. Bowel resection is reserved for frankly non-viable segments. Meticulous haemostasis and avoidance of serosal injury are essential to reduce the risk of postoperative complications such as fistula formation or adhesive obstruction. Minimally invasive techniques have been explored in specialised centres, offering reduced postoperative pain and shorter hospital stay, though open laparotomy remains common. Global awareness of this entity—particularly in regions endemic for tuberculosis or in patients on long-term peritoneal dialysis—facilitates earlier recognition and planning for definitive surgical release. Multidisciplinary coordination with radiology and pathology teams further refines preoperative mapping and postoperative care.

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Surgical Management of Abdominal Cocoon Syndrome publication trend

The graph below shows the total number of articles in surgical management of abdominal cocoon syndrome across all publications each year (not limited to Nature Index journals).

Technical terms

Sclerosing encapsulating peritonitis (SEP): A pathological process in which thick fibrotic tissue encases the small intestine, causing mechanical obstruction.

Adhesiolysis: The surgical separation of fibrous adhesions binding bowel loops to each other or to the peritoneal cavity.

Laparoscopic adhesiolysis: A minimally invasive technique using trocar-based access and video guidance to divide adhesions and release entrapped bowel.

References

1. Abdominal cocoon syndrome (idiopathic sclerosing encapsulating peritonitis): An extremely rare cause of small bowel obstruction—Two case reports and a review of literature. Frontiers in Medicine (2022).
2. Abdominal Cocoon Syndrome: A Laparoscopic Approach. Cureus (2021).
3. Secondary Abdominal Cocoon Syndrome Due To Chronic Beta-Blocker Use. Cureus (2020).