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Year : 2006  |  Volume : 16  |  Issue : 4  |  Page : 483-485
Idiopathic abdominal cocoon

Bangalore Assisted Conception Centre, 6/7,Kumarakrupa Road, High Ground, Bangalore, Pin 560 001, India

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Date of Submission17-Jul-2006
Date of Acceptance10-Oct-2006

Keywords: Idiopathic abdominal cocoon, Sclerosing encapsulating peritonitis

How to cite this article:
Pillai J R, Kumar S N, Praneena. Idiopathic abdominal cocoon. Indian J Radiol Imaging 2006;16:483-5

How to cite this URL:
Pillai J R, Kumar S N, Praneena. Idiopathic abdominal cocoon. Indian J Radiol Imaging [serial online] 2006 [cited 2020 Dec 5];16:483-5. Available from:

   Introduction Top

Abdominal cocoon is a rare condition. It is known in the literature as sclerosing encapsulating peritonitis [1]. It is characterized by partial or complete encasement of small bowel by a thick rind of fibrous tissue and adhesions resulting in clumping of bowel loops. The exact etiology is unclear.

   Case report Top

A thirteen-year-old girl was presented with abdominal pain and occasional vomiting. She has attained menarche at the age of ten years and is having regular cycles. All routine blood and urine examinations were normal. The physical examination showed a vague mass in the umbilical region, which was non-tender and slightly mobile.

The plain radiography of abdomen showed a vague soft tissue mass in the umbilical region with apparent displacement of bowel loops, without any dilatation or pneumoperitoneum [Figure - 1].

The US was inconclusive and showed only a vague clump of bowel loops with relative fixity of bowel loops in the umbilical region and pelvis.

Intravenous contrast enhanced CT scan was done and it showed clumping of small bowel in the umbilical and hypogastric region. A thin enhancing membrane is seen covering it [Figure - 2]. The encased bowel loops show mild dilatation and retention of food residue [Figure - 3]. Minimal inter-loop fluid was also seen. There was no rotation of mesenteric vascular axis or significant dilatation of proximal loops [Figure - 3],[Figure - 4].

Explorative laparotomy revealed a large clump of small bowel surrounded by thin membrane akin to peritoneum. The jejunal loops are seen entering this sac and ileal loops are also seen within. The distal half-meter of ileum was seen outside. The membranous sac was cut and loops were released. The pathological evaluation of membrane showed fibrosis with inflammatory changes. Patient had an uneventful recovery and remains asymptomatic.

   Discussion Top

Abdominal cocoon syndrome is a rare entity [2]. It is known as sclerosing peritonitis or sclerosing encapsulating peritonitis. It may be primary or secondary. The secondary variety is more common and can occur due to multiple causes. It may occur in patients with continuous ambulatory peritoneal dialysis (CAPD), prolonged practalol therapy, sarcoidosis, systemic lupus erythematosus, indwelling abdominal catheters, orthotopic liver transplantation and tuberculosis [3,4]. All these conditions are causes of peritoneal irritation and inflammation, which leads to fibroneogenesis.

The idiopathic (primary) abdominal cocoon is rare and has been described mainly in young girls from tropics [2]. Retrograde menstruation causing peritoneal irritation has been speculated as the possible cause. Rarely idiopathic cocoon syndrome occurs in males and an infective aetiology has been suggested to account for this.

The classic barium study findings are a serpentine or concertina like configuration of dilated small bowel loops in a fixed U shaped cluster. Some authors have described a cauliflower like appearance on barium study [5].

The US examination findings include a vague abdominal mass, relatively fixed small bowel loops and echogenic peritoneal membrane.

The CT findings are peritoneal thickening, signs of obstruction, tethering/ agglutination, fixation of loops, mural thickening, ascites and loculated fluid collections [6]. Peritoneal or mural calcifications may occur rarely. Containment of loops within a sac, the walls of which may show some enhancement is also seen. The entering and exiting bowel loops may be seen in such cases.

Elliptical containment of bowel loops without malrotation and obstruction is seen in both barium and CT examinations.

The treatment consists of surgical release of the membrane, which cures it.

   Conclusion Top

Idiopathic abdominal cocoon is a benign condition commonly seen in adolescent girls and can be diagnosed preoperatively. A CT scan can make the diagnosis clearly in most cases, which help us to plan surgery accurately.

   References Top

1.Owtschinnikow PJ, Peritonitis chronica fibrosa incapsulata. Arch Klin Chir 1907; 83: 623-634.  Back to cited text no. 1    
2.Foo KT, Ng KC, Rauff A, Foong WC, Sinnah R, Unusual small intestinal obstruction in adolescent girls : the abdominal cocoon. BJS 1978; 65: 427-430.  Back to cited text no. 2    
3.Smith L, Collins JF, Morris M, Teele RL, Sclerosing encapsulating peritonitis associated with continuous ambulatory peritoneal dialysis: surgical management. Am J Kidney Dis 1997; 29(3): 456-460.  Back to cited text no. 3    
4.Brown P, Baddeley H, Read AE, Davies JD, Mc Garry J, Sclerosing peritonitis, an unusual reaction to beta-adrenergic blocking drug (practalol). Lancet 1974; 2: 1477-1481.  Back to cited text no. 4    
5.Navani S, Shah P, Pandya S, Doctor N. Abdominal cocoon-the cauliflower sign in barium small bowel series. Indian Journal of gastroenterology 1995; 14 (1): 19.  Back to cited text no. 5    
6.Gupta S, R.G. Shirahatti, Anand J, CT findings of an abdominal cocoon. Am. J. Roentgenol 2004; 183: 1658-1660.  Back to cited text no. 6    

Correspondence Address:
J R Pillai
M.D,DNB. Bangalore Assisted Conception Centre, 6/7, Kumarakrupa road, High ground, Bangalore, Pin-560 001
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-3026.32251

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  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]

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Pakistan Journal of Medical Sciences. 2010; 26(3): 752


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