Coexistence of abdominal cocoon, intestinal perforation and incarcerated Meckel’s diverticulum in an inguinal hernia: A troublesome condition

Abstract

Sclerosing encapsulating peritonitis (SEP) is a rare disease entity, in which the small intestine becomes encased and mechanically obstructed by a dense, fibrotic membrane. The disorder is characterized as either primary (idiopathic) or secondary to other causes. The idiopathic cases of SEP, which lack any identifiable etiology according to clinical, radiological and histopathological findings, are also reported under the designation of abdominal cocoon syndrome. The most frequent presenting symptoms of all SEP cases are nausea, vomiting, abdominal distention and inability to defecate, all of which are associated with the underlying intestinal obstruction. Persistent untreated SEP may advance to intestinal perforation, representing a life-threatening condition. However, preoperative diagnosis remains a particular clinical challenge, and most diagnoses are confirmed only when the typical fibrous membrane encasing the small intestine is discovered by laparotomy. Here, we report the clinical presentation of an 87-year-old male with signs of intestinal obstruction and the ultimate diagnosis of concurrent abdominal cocoon, right incarcerated Meckel’s diverticulum, and gastrointestinal perforation in laparotomy.

Keywords: Sclerosing encapsulating peritonitis; Cocoon syndrome; Perforation; Meckel’s diverticulum

Core tip: Abdominal cocoon syndrome, also known as idiopathic sclerosing encapsulating peritonitis, is a rare disease entity, in which the small intestine becomes encased and mechanically obstructed by a dense, fibrotic membrane. While some patients with cocoon syndrome remain asymptomatic, the majority experience gastrointestinal symptoms, including recurrent attacks of acute, sub-acute or chronic gastrointestinal obstruction, weight loss, loss of appetite, and development of a palpable abdominal mass. Herein, we describe an elderly patient who presented with signs of intestinal obstruction and who was diagnosed with concurrent abdominal cocoon, right incarcerated Meckel’s diverticulum, and gastrointestinal perforation by exploratory laparotomy.