A massive air-fluid level on abdominal skiagram: an indicator of hollow viscous perforation inside an abdominal cocoon

Abstract

Abdominal cocoon syndrome or sclerosing encapsulating peritonitis is a rare cause of intestinal obstruction due to tuberculosis. It may be complicated further with bowel obstruction and perforation. Perforation of hollow viscera inside a cocoon may present with features of peritonitis. Treatment is by excision of the dense sclerosing membrane over the bowel loops addressing the complications if present and specific medical therapy as indicated. However, there is a high risk of recurrence. We hereby describe a case of a 28 years gentleman who presented in emergency department with acute abdomen along with the clinical features of peritonitis and a single large air-fluid level on erect abdominal skiagram. © 2021, Association of Surgeons of India.