EP 620 Endometriosis-Induced Abdominal Cocoon Syndrome Presenting as Intestinal Obstruction

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ID: 323955
2026
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Abstract
Abstract Introduction Abdominal cocoon syndrome, encapsulating peritonitis, or frozen ascites is characterized by encasement of the bowel within a thick fibrocollagenous membrane, causing intestinal obstruction. Case Report A 17-year-old female presented with a feeling of a lump in the right iliac fossa and features of intestinal obstruction, including absence of stool and flatus for three days, with a background of irregular menstrual cycles. Contrast-enhanced CT abdomen revealed matted bowel loops in the right iliac fossa with peritoneal thickening. Due to a non-resolving obstruction, an exploratory laparotomy was performed, which revealed a phlegmon involving the caecum, appendix, and ascending colon, with the terminal ileum encased in a thickened peritoneal membrane forming an abdominal cocoon. Adhesiolysis and release of the bowel were done without the need for resection, and histopathology confirmed endometrial tissue deposits in the resected peritoneum. Postoperative recovery was uneventful. Conclusion Endometriosis, should be considered as a differential diagnosis in young females presenting with intestinal obstruction and atypical imaging findings. Abdominal cocoon secondary to endometriosis is an exceptionally uncommon entity and is often diagnosed intraoperatively. Early surgical intervention with careful adhesiolysis can relieve obstruction and avoid bowel resection.
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Authors Marryam Riaz Farooqui, Hamza Waqar Bhatti, Nazan Hassan, Naveed Akhtar Malik
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag087.633
URL
https://doi.org/10.1093/bjs/znag087.633
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