Introduction: Idiopathic sclerosing encapsulating peritonitis or abdominal cocoon syndrome (ACS) is a rare anatomical deformity characterized by the partial or complete encasement of the small intestine with fibrotic peritoneum. 193 incidents have been described worldwide. The aim of this study was to present two ACS cases successfully treated at the Surgical Clinic of the Agios Dimitrios General Hospital in Thessaloniki, Greece. Presentation of Cases: Two men (55 and 54 years old) presented to the emergency department complaining of abdominal pain, distension, constipation, nausea, and vomiting. Neither of these patients had surgical histories. The computed tomography of the first patient showed considerable distension of the small bowel, suggestive of an internal hernia. The second case showed distention of the jejunum with no obvious cause. Both patients underwent emergency surgery. Intraoperatively, we found that a fibrous membrane had completely covered the small intestine of the first patient, and the jejunum and part of the large intestine of the second patient. Adhesiolysis and a partial excision of the membrane were performed in both cases. Discussion: ACS is a rare cause of small bowel ileus. Although pharmaceutical treatments with immunosuppressants and steroids have been described, surgical treatment is the gold standard.  Conclusion: Preoperative clinical suspicion of this disease can help determine the diagnosis and protect surgeons from intraoperative “surprises.”

Author(s) Details

Apostolos Sovatzidis
Healthcare Center of Evosmos, Thessaloniki, Greece.

Eirini Nikolaidou
Department of Plastic, Reconstructive and Hand Surgery and Burns ICU, General Hospital of Thessaloniki “G. Papanikolaou”, Thessaloniki, Greece.

Anastasios Katsourakis
Department of Surgery, Agios Dimitrios General Hospital, Thessaloniki, 54634, Greece.

George Noussios
School of Physical Education and Sports Sciences, Aristotle University of Thessaloniki, 54623, Greece.

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