Abdominal cocoon syndrome with military tuberculosis.

Abdominal cocoon syndrome coexistent with military tuberculosis is a very rare entity, and its occurrence in a young adult male has not been previously reported. The disease in combination with military tuberculosis is associated with significant morbidity and mortality if underdiagnosed and untreated; hence, a high index of suspicion is required in a patient with tuberculosis presenting with intestinal pseudo-obstruction. The ideal treatment of the combination is surgical excision of cocoon along with oral anti-tubercular therapy (ATT), when the initial conservative management fails. However, surgery is frequently complicated by iatrogenic enterotomy due to the fibrinous cocoon. The best option in these cases may be a bail-out method of diverting jejunostomy. This helps relieve intestinal pseudo-obstruction and promotes early initiation of ATT as has been demonstrated in the present case.