Encapsulating peritoneal sclerosis: a case report of cocoon syndrome, an unusual cause of bowel obstruction

Abstract

Encapsulating peritoneal sclerosis (EPS), also known as cocoon syndrome, is a rare cause of bowel
obstruction in which the small intestine is encased by a thin fibrous membrane. We report the case of
a 76-year-old male patient with no history of abdominal surgery who presented with colicky abdominal pain, vomiting, and abdominal distension. A computed tomography (CT) scan revealed severe bowel obstruction. During surgery, loops of the ileum were found to be encased in fibrous tissue, confirming a type II EPS. The adhesions were released and intraoperative intestinal perforations were repaired. The patient evolved with favorable outcome. The diagnosis is often complex and is frequently confirmed during surgery. A CT scan helps guide treatment by revealing dilated loops and thickened membranes. 
There are no standardized international guidelines. In cases of obstruction, surgery is the treatment of choice. This case highlights the importance of considering EPS in patients with no history of surgery.