A Diagnostic Dilemma for Acute Abdomen: Sclerosing Encapsulating Peritonitis (Abdominal Cocoon Syndrome); A Retrospective Cohort Study

Background: Sclerosing encapsulating peritonitis (SEP) is a rare cause of acute abdomen and can be easily misdiagnosed. Preoperative diagnosis of the SEP can be performed with preoperative imaging studies. We aimed to evaluate the clinical features of ileus cases who were diagnosed with primary or secondary SEP in the last five years.

Methods: This retrospective cohort study evaluated the patients who were admitted with ileus or acute abdomen symptoms to the Emergency Department of Elazığ Training and Research Hospital and underwent surgery by the same surgical team of General Surgery Department between January 2014 and January 2019. Patients who were diagnosed with primary or secondary SEP were included. The demographic data, clinical presentation, whether the disease was primary or secondary, the treatment options performed and mortality rates were evaluated.

Results: SEP was observed in 11 of the patients. Ten patients underwent surgery (90.9%), and one patient (9.1%) was treated conservatively. Of the patients, six had secondary SEP (54.5%) and five had primary SEP (45.5%). In total, five patients were female (45.5%) and six were male (54.5%). The median age of the patients was 35 years (24-69). The median age of the patients with primary disease was 48 (29-69) years, while the median age of patients with secondary disease was 34.5 (24-64) years. One patient expired in the postoperative 8th hour.

Conclusion: SEP should be considered in the case of recurrent abdominal pain attacks, especially in patients undergoing peritoneal dialysis, and it should be known that the mortality rate is high when misdiagnosed.