Small bowel obstruction secondary to abdominal cocoon syndrome: Case report and review of the literature

Introduction Abdominal Cocoon Syndrome (ACS), also known as idiopathic sclerosing encapsulating peritonitis, is a rare cause of small bowel obstruction characterized by a fibrocollagenous membrane encasing the intestinal loops. Its preoperative diagnosis remains challenging due to nonspecific clinical and imaging findings. Although more commonly reported in young males from tropical regions, idiopathic forms can occur in older adults without predisposing factors. Case presentation We report the case of a 58-year-old male with no history of abdominal surgery or tuberculosis who presented with recurrent abdominal pain, distension, nausea, and vomiting for three months. Computed tomography revealed clustered small-bowel loops with a transition zone in the right iliac fossa. After unsuccessful conservative management, exploratory laparotomy demonstrated the small intestine enveloped in a thick, whitish fibrous membrane. Complete adhesiolysis and membrane excision were performed without bowel resection. The postoperative course was uneventful. Discussion ACS is a rare entity that should be suspected in cases of recurrent or unexplained small bowel obstruction. Although computed tomography may suggest the diagnosis through the characteristic "cauliflower sign," surgical exploration remains the gold standard for confirmation and treatment. A review of the recent literature (2015–2024) shows that most patients achieve excellent outcomes following adhesiolysis and membrane excision, whether by open or laparoscopic approach. Conclusion In patients with recurrent, unexplained small bowel obstruction, ACS should be considered. Early surgical intervention ensures definitive treatment and prevents complications.