Meckel’s cocoon: A rare case of abdominal cocoon with Meckel’s diverticulum

Abstract

Abdominal cocoon syndrome (ACS), also known as sclerosing encapsulating peritonitis, is a rare cause of intestinal obstruction in which there is partial or total encapsulation of abdominal viscera within a dense fibrous membrane. It was first described by Foo et al. [1] in 1978. This condition was thought to be related to retrograde menstruation. However, sporadic cases have been reported in both children and men, hence the exact aetiology remains unknown. This disease is characterized as either primary (idiopathic) or secondary to other causes. It is often confused with peritoneal encapsulation (PE) which is a congenital anomaly. It invariably presents as an acute or subacute intestinal obstruction with or without a mass. Diagnosis is mostly made after exploratory laparotomy and histopathological analysis of the sac. Herein, we present the case of a 38-year-old male who presented with features of acute intestinal obstruction. At laparotomy, small bowel loops were found encased in a cocoon with a tight ring at the base which resulted in bowel wall necrosis; Meckel’s diverticulum was also present within the cocoon. Resection of the cocoon and anastomosis was performed. A better awareness of these conditions will facilitate proper management when encountered as an emergency.