The etiology of this entity has remained relatively unknown. The abdominal cocoon has been classically described in young adolescent females from the tropical and subtropical countries, but adult case reports from temperate zones can be encountered in literature[1,22-27
]. To explain the etiology, a number of hypotheses have been proposed. These include retrograde menstruation with a superimposed viral infection, retrograde peritonitis and cell-mediated immunological tissue damage incited by gynecological infection. However, since this condition has also been seen to affect males, premenopausal females and children, there seems to be little support for these theories[1,24-28
]. Further hypotheses are therefore needed to explain the cause of idiopathic SEP. Since abdominal cocoon is often accompanied by other embryologic abnormalities such as greater omentum hypoplasia, and developmental abnormality may be a probable etiology[1
]. Greater omentum hypoplasia and mesenteric vessel malformation was demonstrated in some cases. To elucidate the precise etiology of idiopathic SEP, further studies of cases are necessary.
The secondary form of SEP has been reported in association with continuous ambulatory chronic peritoneal dialysis (PD)[29-38
]. SEP is a serious complication of PD which leads to decrease ultrafiltration and ultimately intestinal obstruction. For some authors[37
], the incidence of SEP was 1.2%, but rose to 15% after 6 years, and 38% after 9 years on PD. The risk of SEP is low early in the course of PD, but increases progressively at 6 years and beyond. For others, the respective cumulative incidences of peritoneal sclerosis at 3, 5 and 8 years were 0.3%, 0.8% and 3.9%. This condition was independently predicted by younger age and the duration of PD, but not the rate of peritonitis[33
]. Other rare causes of secondary form of SEP[39-52
] include, prior abdominal surgery, subclinical primary viral peritonitis, recurrent peritonitis, beta-blocker treatment (practolol), peritoneovenous shunting, pertioneoventricular shunting and, more rarely, abdominal tuberculosis, sarcoidosis, familial Mediterranean fever, intraperitoneal chemotherapy, cirrhosis, liver transplantation, gastrointestinal malignancy, luteinized ovarian thecomas, endometriosis, protein S deficiency, dermoid cyst rupture, and fibrogenic foreign material.