Abstract
Abdominal cocoon syndrome (ACS) is a rare cause of intestinal obstruction characterized by the encasement of the small intestine in a fibrocollagenous membrane, making preoperative diagnosis challenging. We present the case of a 15-year-old male with acute intestinal obstruction, where a contrast-enhanced computed tomography scan revealed a pathognomonic cocoon-like structure and concurrent gut malrotation. The diagnosis was confirmed intraoperatively, and management involved membrane excision, adhesiolysis, and a simple appendectomy for a secondarily involved appendix. This case is clinically significant for demonstrating tailored intraoperative decision-making; the appendicular involvement was correctly identified as a secondary consequence of the cocoon's chronic inflammation, thus avoiding an unnecessary hemicolectomy. This report underscores ACS as a critical differential diagnosis for intestinal obstruction in young males, particularly in tropical regions, and highlights that early, pathology-guided surgical intervention is essential for favorable outcomes.