Cocoon Syndrome: A Clinical Case of Intestinal Obstruction Highlighting the Diagnostic and Therapeutic Importance of Exploratory Laparoscopy in the Face of Ambiguous Imaging

Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine

Cocoon syndrome, also known as sclerosing encapsulating peritonitis (SEP), is a rare condition characterized by the encapsulation of small bowel loops by a thick fibrocollagenous membrane. Its non-specific clinical presentation and ambiguous findings on conventional imaging often lead to significant diagnostic delays or misdiagnosis, frequently being mistaken for internal hernias or neoplastic processes. We present the case of a 61-year-old male patient with no prior abdominal surgical history who presented with a six-month history of recurrent abdominal pain, vomiting, and weight loss. While magnetic resonance imaging and computed tomography suggested a high-grade intestinal obstruction, they could not definitively rule out an underlying malignancy. Exploratory laparoscopy was performed, revealing a dense fibrin mantle encapsulating the small bowel loops and a carnified greater omentum. Extensive laparoscopic blunt and bipolar adhesiolysis was successfully carried out, achieving complete intestinal release. The patient experienced an excellent postoperative recovery and was discharged five days after the procedure. This case highlights the pivotal role of exploratory laparoscopy as a minimally invasive tool that provides both definitive diagnostic confirmation and effective surgical treatment, reducing the morbidity associated with traditional laparotomy in cases of ambiguous intestinal obstruction.