Abdominal cocoon [encapsulating peritoneal sclerosis (EPS)] is a rare cause of intestinal obstruction characterized by the formation of a fibrocollagenous peritoneal membrane that encases abdominal viscera, mainly small intestinal loops. It is believed to be a result of a chronic intra-abdominal fibro-inflammatory process that results in the formation of marbled, thickened leathery cocoon-like fibroconnective tissue sheets that cover, fix, and ultimately constrict the gut compromising its motility. EPS can be primary (idiopathic) or secondary to several other causes like long-term peritoneal dialysis, postrenal transplantation, abdominal tuberculosis (TB), peritoneal shunts, etc. The etiology of the primary EPS is unknown, and diagnosis is mostly made after exploratory laparotomy and histopathological analysis of the sac. Surgical exploration with resection of thick membranes and associated adhesions is the mainstay of the treatment. The condition has a good postoperative outcome, provided it is diagnosed and managed early. We herein report an unusual case of a 43-year-old patient who developed intestinal obstruction-like symptoms with vomiting and abdominal pain. Computed tomography (CT) scan revealed typical findings of the abdominal cocoon which was later confirmed at surgery. To our best knowledge, only a few such cases have been reported so far.
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