Trapped in a Cocoon: A Case of Peritoneal Encapsulation Syndrome Presenting as Recurrent Bowel Obstruction

Peritoneal Encapsulation Syndrome (PES) is a rare congenital anomaly in which the small bowel is partially or completely enclosed within an accessory peritoneal membrane. Its clinical presentation often mimics other causes of small bowel obstruction, making preoperative diagnosis difficult. We report a case of a 48-year-old male who presented with recurrent diffuse abdominal pain, distension, and intermittent vomiting, with a similar episode one year earlier managed conservatively. Examination revealed a tender abdominal lump and hyperperistaltic bowel sounds. Imaging with contrast-enhanced CT demonstrated a thick fibrous capsule encasing the small bowel, suggestive of abdominal cocoon syndrome. Emergency laparotomy revealed a pseudo membrane covering most of the small bowel, dense adhesions, and a pus pocket within a clumped ileal segment. Surgical management included membrane excision, adhesiolysis, resection of the affected ileal segment, and double-barrel ileostomy. The patient had an uneventful recovery and was discharged in stable condition. This case illustrates that, although PES is classically a benign congenital anomaly, secondary inflammatory changes may develop, leading to complications requiring bowel resection. PES should be considered in adults with unexplained recurrent small bowel obstruction, and timely surgical intervention can lead to favourable outcomes.