PMC4189066_01
Axial contrast enhanced CT scan. Note the clump of small bowel loops with minimal fluid around it inside the cocoon. Capsule of cocoon (white arrow). Loop entering through opening (black thin arrow).
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No evidence of vascular axis rotation (Figs. 1 and 2).
Para sagittal reconstructed CT image. The cocoon (white thick arrow). Proximal dilated loop (black thin arrow).
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No evidence of vascular axis rotation (Figs. 1 and 2).
Grayish-pink membrane covering the small bowel forming a cocoon. (For interpretation of the references to color in figure legend, the reader is referred to the web version of the article.)
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Diagnostic laparoscopy showed that most of the small bowel was wrapped up in a grayish-pink membrane forming a cocoon (Fig. 3).
Encased small bowel loops were separated with excision of the whole membrane.
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Encased small bowel loops were separated by sharp dissection (Fig. 4).
The appendix was embedded in the membrane.
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Appendectomy was done as the appendix was embedded in the membrane (Fig. 5).
High power view displaying dense poorly cellular collagenised fibrous tissue.
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Histopathology of the membrane, showed dense poorly cellular collagenised fibrous tissue, features consistent with sclerosing encapsulating peritonitis (abdominal cocoon; Fig. 6).