Sclerosing Encapsulating Peritonitis (Abdominal Cocoon)


Primary/Idiopathic Sclerosing Encapsulating Peritonitis

  • Epidemiology
    • Described in young females in tropical/subtropical countries (although there are case reports in adults from temperate zones)
    • Associated with: often other embryologic abnormalities (such as greater omentum hypoplasia and mesenteric vessel malformation)
  • Possible Mechanisms
    • Retrograde menstruation with superimposed viral infection: however, this doesnt explain cases occurring in males, premenopausal females, and children

Secondary Sclerosing Encapsulating Peritonitis

Peritoneal Dialysis (PD) (seee Peritoneal Dialysis, [[Peritoneal Dialysis]])

  • Risk Factors
    • Duration of Time on Peritoneal Dialysis
      • Incidence of 1.2% 0-> increases to 15% after 6 years on PD -> increases to 38% after 9 years on PD [MEDLINE]
      • Incidence of 0.3% after 3 years -> increases to 0.8% after 5 years -> increases to 3.9% after 8 years on PD [MEDLINE]
    • Younger Age [MEDLINE]
    • Note: the rate of peritonitis does not appear to be a risk factor [MEDLINE]


  • Abdominal Tuberculosis (see Tuberculosis, [[Tuberculosis]])
  • Cirrhosis (see End-Stage Liver Disease, [[End-Stage Liver Disease]])
  • Dermoid Cyst Rupture
  • Endometriosis (see Endometriosis, [[Endometriosis]])
  • Familial Mediterranean Fever (FMF) (see Familial Mediterranean Fever, [[Familial Mediterranean Fever]])
  • Fibrogenic Foreign Material in Peritoneal Space
  • Gastrointestinal Malignancy
  • Intraperitoneal Chemotherapy
  • Liver Transplant (see Liver Transplant, [[Liver Transplant]])
  • Luteinized Ovarian Thecoma
  • Peritoneovenous Shunting
  • Pertioneoventricular Shunting
  • Practolol (see Practolol, [[Practolol]])
  • Protein S Deficiency (see Protein S Deficiency, [[Protein S Deficiency]])
  • Prior Abdominal Surgery
  • Recurrent Peritonitis
  • Sarcoidosis (see Sarcoidosis, [[Sarcoidosis]])
  • Subclinical Primary Viral Peritonitis

Clinical Manifestations

General Comments

  • Asymptomatic: some cases

Gastrointestinal Manifestations

Renal Manifestations

  • Ultrafiltration Failure: for PD-related cases

Other Manfestations

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  • Incidence of encapsulating peritoneal sclerosis at a single U.S. university center. Adv Perit Dial. 2010;26:75-81 [MEDLINE]

  • Encapsulating peritoneal sclerosis: incidence, predictors, and outcomes. Kidney Int. 2010 May;77(10):904-12. doi: 10.1038/ki.2010.16. Epub 2010 Mar 10 [MEDLINE]

  • World J Gastroenterol 2012 May 7; 18(17): 1999-2004 [MEDLINE]