Encapsulating peritoneal sclerosis
Citation, DOI, disclosures and article data
At the time the article was created The Radswiki had no recorded disclosures.View The Radswiki's current disclosures
Encapsulating peritoneal sclerosis is a rare benign cause of acute or subacute small bowel obstruction. It is characterized by total or partial encasement of the small bowel within a thick fibrocollagenous membrane.
The condition was originally termed abdominal cocoon. The condition is popularly known as sclerosing encapsulating peritonitis, however, this is somewhat of a misnomer as inflammation is not always present 5. It has also been known as sclerosing peritonitis, encapsulating peritonitis, and peritonitis chronica fibrosa incapsulata.
Encapsulating peritoneal sclerosis can occur at any age, with reports ranging from 2-day neonate to 82 years 5.
The presentation is non-specific and patients may present with vomiting, abdominal pain and/or subacute bowel obstruction 5.
It can be idiopathic or secondary due to:
continuous ambulatory peritoneal dialysis (prevalence ~0.7%)
treatment with practolol
Various abdominal disorders such as sarcoidosis, familial Mediterranean fever, gastrointestinal malignancy, ovarian carcinoma 6, protein S deficiency, liver transplantation, fibrogenic foreign material, and luteinised ovarian thecomas are other rare causes.
Abdominal radiographic appearances are nonspecific and may be normal or may show:
gas-fluid levels similar to those in patients with any other cause of small-bowel obstruction
the wall of the "cocoon" may calcify
clumped bowel loops
trilaminar appearance of a hyperechoic membrane, hypoechoic bowel wall and hyperechoic bowel contents
ascites may be present 5
In the appropriate clinical setting, recognition of the entire dilated small bowel at the center of the abdomen and encased within a thick fibrocollagenous membrane, as though it were in a cocoon, is diagnostic of sclerosing encapsulating peritonitis. Other imaging findings may include:
enhancing peritoneum, thickened >2 mm 5
signs of small intestinal obstruction
fixation of intestinal loops
ascites or localized fluid collections (especially interbowel)
bowel wall thickening
peritoneal or mural calcification
calcified and/or reactive adenopathy
MRI will demonstrate the same features as CT, although it may better discriminate between thickened bowel and the peritoneal membrane than CT 5.
Encapsulating peritoneal sclerosis may be confused with congenital peritoneal encapsulation, which is characterized by a thin accessory peritoneal sac surrounding the small bowel.
- 1. Demir MK, Akinci O, Onur E et-al. Case 108: sclerosing encapsulating peritonitis. Radiology. 2007;242 (3): 937-9. doi:10.1148/radiol.2423040788 - Pubmed citation
- 2. Gupta S, Shirahatti RG, Anand J. CT findings of an abdominal cocoon. AJR Am J Roentgenol. 2004;183 (6): 1658-60. doi:10.2214/ajr.183.6.01831658 - Pubmed citation
- 3. Hur J, Kim KW, Park MS et-al. Abdominal cocoon: preoperative diagnostic clues from radiologic imaging with pathologic correlation. AJR Am J Roentgenol. 2004;182 (3): 639-41. doi:10.2214/ajr.182.3.1820639 - Pubmed citation
- 4. Troidle L, Gorban-Brennan N, Kliger A et-al. Continuous peritoneal dialysis-associated peritonitis: a review and current concepts. Semin Dial. 2004;16 (6): 428-37. Pubmed citation
- 5. Singhal M, Krishna S, Lal A et-al. Encapsulating Peritoneal Sclerosis: The Abdominal Cocoon. (2019) Radiographics : a review publication of the Radiological Society of North America, Inc. 39 (1): 62-77. doi:10.1148/rg.2019180108 - Pubmed
- 6. Isacson R, Segal A, Alberton J et-al. Abdominal cocoon: a potential pitfall in patients with ovarian carcinoma. (2012) Tumori. 98 (6): 176e-8e. doi:10.1700/1217.13517 - Pubmed