A Case Report of Abdominal Cocoon Sydrome And Small Intestinal Bezoar

Background: Sclerosing encapsulated peritonitis (SEP), referred to as abdominal cocoon syndrome, is an uncommon clinical etiology of acute mechanic intestinal obstruction. It is characterized by the small intestine being partially or completely covered by a white fibrocollagen membrane layer that resembles a cocoon. Bezoars are solid formations primarily made up of undigested food remnants and are an uncommon cause of acute intestinal obstruction.
Case presentation: A 58-year-old female patient with no history of previous abdominal surgery and no comorbidities was admitted to our hospital with clinical symptoms of intestinal obstruction. Following the necessary imaging and examinations, an emergency diagnostic laparotomy was performed with the diagnosis of acute mechanical intestinal obstruction. Intraoperatively, abdominal cocoon syndrome and a 3 cm sized bezoar was detected in the jejunum and completely obstructing the lumen. It was thought that this patient's abdominal cocoon syndrome may have contributed to his chronic constipation and ultimately to the development of bezoar, thus causing acute mechanical intestinal obstruction.
Conclusion: Careful evaluation of the underlying causes is essential in patients with acute mechanical intestinal obstruction, particularly when clinical symptoms are non-specific and common risk factors are absent. Early identification of bezoars and timely intervention may reduce the need for surgery in selected cases. Especially in SEP cases, the surgical approach plays a key role in both diagnosis and treatment. Clinicians should be aware that although SEP and intestinal bezoars are individually rare, they can occasionally occur together, making intraoperative assessment and management crucial for a successful outcome.