Type III abdominal cocoon syndrome presenting as mechanical small bowel obstruction: a rare pediatric case report

Introduction and importance: Abdominal cocoon syndrome, or sclerosing encapsulating peritonitis (SEP), is a rare cause of intestinal obstruction characterized by encasement of the bowel within a fibrous membrane. Its nonspecific presentation often delays diagnosis, with most cases identified intraoperatively. Type III SEP, involving the small bowel and additional abdominal organs, is especially uncommon. Case presentation: A 14-year-old Somali female presented with a 5-month history of intermittent abdominal pain and greenish vomiting, with acute worsening in the preceding 5 days. Examination and imaging indicated small bowel obstruction. Contrast-enhanced CT revealed clustered dilated small bowel loops with collapsed distal segments. Exploratory laparotomy demonstrated a thick fibrous membrane encasing the entire small bowel, cecum, and left colon, confirming Type III abdominal cocoon syndrome. The membrane was completely excised, and a prophylactic appendectomy was performed. The patient had an uneventful postoperative recovery and remained asymptomatic at her 2-month follow-up. Clinical discussion: Abdominal cocoon syndrome is difficult to diagnose preoperatively due to its rarity and vague clinical features. Type III disease is extremely rare and poses additional diagnostic and surgical challenges. Although imaging may suggest the condition, definitive diagnosis is typically made during surgery. Membrane excision is the standard treatment and generally results in excellent outcomes when performed promptly. Conclusion: Abdominal cocoon syndrome should be considered in patients with unexplained intestinal obstruction. Early surgical intervention leads to favorable outcomes. This case represents a rare instance of Type III abdominal cocoon syndrome in Somalia, underscoring the need for heightened clinical suspicion and timely management in low-resource settings, underscoring the need for heightened clinical suspicion and timely management in low-resource settings.