Mansoor Banday1, Sehrish Rauof2

1Department of General Surgery, Esi Postgraduate Institute of Medical Sciences and Research and Hospital, Basaidarapur, New Delhi, India
2Department of Nephrology, Government Medical College, Srinagar, India


Objective: Cocoon abdomen or sclerosing encapsulating peritonitis is a rare condition characterized by bowel entrapment in a cocoon-like membrane. Primary and secondary types have been described. Most patients present acutely with intestinal obstruction or peritonitis but history of long standing chronic symptoms may be present. The condition is usually not detected on imaging, and diagnosis at laparotomy is common. Surgical treatment includes excision of the membrane with adhesiolysis.

Material and Methods: A 5-year study of the patients operated for cocoon abdomen in our hospital was conducted. Analysis of patient symptoms, imaging findings, intra-operative findings and histopathology was carried out.

Results: Five males and three females were included into the study. Mean age was 29.6 years. Five patients presented with acute intestinal obstruction and three patients with perforation peritonitis. Laparotomy was performed in all cases. Successful excision of the membrane was done in all patients of obstruction while membrane excision could only be done in one patient of peritonitis. Histopathology revealed tuberculosis in six patients, one patient was already on anti-tubercular treatment and one patient had carcinoma. There was one mortality.

Conclusion: Cocoon abdomen is a rare condition. Tuberculosis should always be considered as a cause in endemic areas. Surgery is the preferred treatment and involves excision of the membrane but can be difficult in patients with superadded peritonitis or malignancy.

Keywords: Cocoon abdomen, perforation peritonitis, sclerosing encapsulating peritonitis, tuberculosis, cocoon carcinomata

Cite this article as: Banday M, Rauof S. Secondary encapsulating peritonitis: a study of cases over five years. Turk J Surg 2019; 35 (3): 171-177.


Ethics Committee Approval

Ethics committee approval was not needed as all patients presented with acute abdomen and needed surgical intervention.

Peer Review

Externally peer-reviewed.

Author Contributions

Consept - M.B.; Design - M.B.; Supervision - S.R.; Resource - M.B.; Materials - S.R.; Data Collection and/or Processing - M.B.; Analysis and Interpretation - M.B.; Literature Search - S.R.; Writing Manuscript - M.B., S.R.; Critical Reviews - M.B., S.R.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.