Current Research on Abdominal Cocoon Syndrome: Two Cases of an Anatomical Abnormality

Introduction: Idiopathic sclerosing encapsulating peritonitis or abdominal cocoon syndrome (ACS) is
a rare anatomical deformity characterized by the partial or complete encasement of the small intestine
with fibrotic peritoneum. 193 incidents have been described worldwide. The aim of this study was to
present two ACS cases successfully treated at the Surgical Clinic of the Agios Dimitrios General
Hospital in Thessaloniki, Greece.
Presentation of Cases: Two men (55 and 54 years old) presented to the emergency department
complaining of abdominal pain, distension, constipation, nausea, and vomiting. Neither of these
patients had surgical histories. The computed tomography of the first patient showed considerable
distension of the small bowel, suggestive of an internal hernia. The second case showed distention of
the jejunum with no obvious cause. Both patients underwent emergency surgery. Intraoperatively, we
found that a fibrous membrane had completely covered the small intestine of the first patient, and the
jejunum and part of the large intestine of the second patient. Adhesiolysis and a partial excision of the
membrane were performed in both cases.
Discussion: ACS is a rare cause of small bowel ileus. Although pharmaceutical treatments with
immunosuppressants and steroids have been described, surgical treatment is the gold standard.
Conclusion: Preoperative clinical suspicion of this disease can help determine the diagnosis and
protect surgeons from intraoperative “surprises.”