原发性腹茧症合并隐睾术前误诊4例

目的:提高腹茧症的诊治水平.方法:我院2006-01/12收治的原发性腹茧症患者4例临床资料,以急性肠梗阻入院,查体发现均合并单侧隐睾,全部病例行剖腹探查.结果:术中证实腹茧症诊断,手术方案采取全部或部分包膜切除、肠黏连松解、肠排列术等,均痊愈出院.结论:腹茧症临床表现无特异性,术前诊断困难,对合并隐睾的肠梗阻应考虑到腹茧症的可能,手术治疗是腹茧症有效的治疗方法.     

腹茧症致剧烈腹痛1例

本文所遇1例急性腹痛者由罕见病腹茧症引起,现报道于下. 患者男,45岁,干部.因突发上腹剧痛4 h入院.患者于4 h前无明显诱因突发持续性上腹部剧痛,难以忍受,无放射痛,伴恶心,未呕吐,无发热、黄疽、心慌、胸闷,大小便正常.既往身体健康,1年前曾因类似症状在外院住院,疑诊急性胰腺炎,经治好转出院,无外伤、手术史.杏体:体温36.6℃,脉搏84次.min,呼吸16次.min,血压120.80 mmHg.     

腹茧症手术治疗1例

患者,男,19岁,因“腹部胀痛,停止肛门排气、排便4天”。入院,既往无腹部外伤史及手术史,入院查体,一般情况尚可,痛苦貌。皮肤粘膜无黄染,浅表淋巴结未及肿大,眼窝稍凹陷,口唇干燥。心肺无异常。腹部稍膨胀,无局限性隆起,未见胃、肠型及蠕动波,腹肌稍紧,未触及包块,脐周压痛,无反跳痛。腹部叩鼓,无移动性浊音,肠鸣音稍亢进。无腹外疝。     

腹茧症一例

患者男，56岁，因腹胀、腹痛伴消瘦7个月入院。患者7个月前无诱因出现右下腹胀，脐周绞痛，稀便1～2次／日，无脓血和黏液；排便后腹痛不缓解。无恶心、呕吐，无发热、盗汗。当地医院查腹部B超及CT提示“少量腹水”；全消化道造影：“空肠上段不全梗阻”；胃镜、肠镜检查未见异常。按“结核性腹膜炎，不全肠梗阻”予异烟肼、利福平、环丙沙星1个月，但腹痛、腹胀无缓解。发病以来体重下降15kg。既往体健。其父患有“结核性胸膜炎”，已故2年。     

腹茧症3例

腹茧症(abdominal cocoon)是一种罕见的疾病,国内外对本病报道较少,命名也不一致,如局限性小肠外膜包绕症、包裹性纤维性慢性腹膜炎、先天性小肠禁锢症、小肠节段性纤维包裹症等。1978年Foo等将其命名为腹茧症,该名称被较为广泛地接受。其病理解剖特点为部分或全部小肠被一层致密、灰白色、质地韧厚的纤维呈蚕茧状包裹,也有报道认为小肠被透明菲薄的膜所包裹,病因尚不明确。本文结合文献资料和3例腹茧症病例的诊断治疗体会,就本病的病因、病理和临床特点进行讨论。 例1:患者,女,24岁,因反复腹痛5年入院。患者自诉有     

手术治疗腹茧症20例临床分析

目的探讨腹茧症的临床表现、诊断及治疗方法。方法回顾性分析2012-01~2017-06该院收治的20例腹茧症患者的临床资料。结果腹茧症主要临床特征为完全性或部分性肠梗阻(65.0%)和腹部包块(40.0%),10例CT检查示小肠壁增厚、纠集并走形紊乱,8例腹部X线检查示肠管扩张,积气积液,可见液气平面,4例行消化道钡剂造影见近端小肠扩张,局部肠管走形紊乱,集中于中腹部。所有患者均进行手术治疗,8例术后发生并发症(40.0%),肠梗阻3例(15.0%),切口感染3例(15.0%),吻合口瘘1例(5.0%),并发多器官功能障碍综合征(MODS)并死亡1例(5.0%)。结论腹茧症临床特征不典型,术前诊断困难,CT和消化道造影对于术前诊断具有重要价值,治疗主要依靠外科手术,术后并发症发生率高。     

原发性腹茧症的诊断及治疗（附7例报告）

目的探讨原发性腹茧症的临床特点及其诊治方法。方法对7例原发性腹茧症患者的临床资料作回顾性分析。结果 7例患者中5例表现为单纯性肠梗阻,1例表现为腹部包块并伴有不全梗阻,1例在腹腔镜阑尾切除术时意外发现。所有患者均进行了腹部立位X线平片检查,6例表现为不同程度肠管积气扩张,其中5例可见液气平面。3例行腹部CT检查,可见肠管被一层致密组织包裹成团,积气扩张、聚集成团呈菜花样改变。均行手术治疗,术中发现全部或部分小肠被一层质韧乳白色膜样物包裹、覆盖;大网膜呈不同程度缺如。解除肠梗阻后分离、切除包膜送检,病理检查示其由大量纤维结缔组织构成,其间可见中性粒细胞、淋巴细胞等浸润。结论如患者出现其他原因难以解释的肠梗阻症状或包块,应考虑原发性腹茧征的可能。影像学检查特别CT检查是诊断原发性腹茧症的有效方法。以手术为主的综合治疗是原发性腹茧症的主要治疗方法,治疗以手术解除梗阻和分离切除包膜为主,但无症状者不建议手术。     

腹茧症7例诊治体会

腹茧症临床少见，病因不明，特点是腹腔全部或部分脏器被一层灰白色质韧、厚硬的纤维外膜包裹，包裹内容物以小肠最为常见，形似蚕茧。本病常以腹部包块或肠梗阻为首发症状，术前诊断困难，治疗以手术为主。1999年7月～2008年7月，我们院共收治本病患者7例。现将诊治体会介绍如下。     

腹茧症的诊治探讨（附6例报告）

目的探讨腹茧症的临床特点及诊治方法。方法回顾性分析我院收治的6例腹茧症病人的临床资料。结果临床表现为腹痛腹胀4例，腹部包块2例，术前均未明确诊断，分别误诊为卵巢肿瘤蒂扭转2例，急、慢性肠梗阻4例，术中发现大网膜缩短4例，缺如2例，全部或部分小肠被一层灰白色致密坚韧的纤维膜包裹，均行手术松解治疗，术后病理检查确诊为腹茧症。结论腹茧症临床表现无特异性，术前诊断困难，需手术及病理确诊，以手术治疗为主，手术方式以单纯粘连松解术为宜。     

中国腹茧症14年流行病学特征

目的: 探讨中国近14年腹茧症的流行病学特征和诊疗经验.方法: 联合检索中国生物医学文献数据库和中国知识资源总库等多家中文数据库1994-01/2007-06有关腹茧症的文章,总结分析腹茧症的流行病学特征和诊治经验.结果: 中国近14年共报道776例腹茧症,男女比例为1:1.37,平均年龄29.3岁,57%分布在华东地区,91.5%以不同表现形式的肠梗阻为主要症状,68.3%属于弥漫型腹茧症,40.5%患者无大网膜.手术以包膜切除为主.结论: 腹茧症主要分布在华东地区,术前诊断困难,切除包膜和松解粘连是治疗此病有效方法.     

Sclerosing encapsulating peritonitis presenting with paroxysmal abdominal pain and strangulated mechanical bowel obstruction: A case report

Rationale:Sclerosing encapsulated peritonitis (SEP) is a rare chronic peritoneal inflammation with unknown etiology, and is also known as abdominal cocoon. This occurs when the intestinal annulus is enveloped in the peritoneal cavity, resulting in intestinal obstruction. Its preoperative diagnosis and treatment strategy remains a challenge.Patient concerns:The study reports a 53-year-old male, who presented with a 4-day history of paroxysmal abdominal pain, without the adverse reaction of nausea, vomiting, or diarrhea.Diagnosis:The accurate diagnosis of SEP was made after the emergency diagnostic laparoscopy.Interventions:The laparoscopic exploration revealed that the small intestine was wrapped by a layer of peritoneum. Then, the abdominal fibrous membrane was removed surgically, and adhesiolysis were performed. The patient recovered well, and gradually recovered by the 10^th post-operative day.Outcomes:The patient was discharged uneventfully after 10 days, and the patient recovered well. After the 12-month follow-up, no symptoms of recurrence or complications were observed.Lessons:The preoperative diagnosis of SEP remains difficult, and the onset of SEP has exhibited a younger trend. The diagnosis of SEP should remain on the list of differential diagnosis for paroxysmal abdominal pain. single-photon emission computed tomography/computed tomography and laparoscopic exploration have been proven to be helpful for establishing the diagnosis. In the early stage of intestinal obstruction caused by SEP, surgical intervention was immediately carried out in emergency department, and the patient recovered well after the operation. The present study also presents a review of the literature for other cases of SEP. The external evidence was helpful in making clinical decisions for patient care.     

Diverticulosis of the jejunum with intestinal obstruction： A case report

A diagnosis of intestinal diverticulosis is difficult to make pre-operatively because the clinical symptoms are usually non-specific. We report the case of a 70-year-old man who had suffered from three episodes of intestinal obstruction in 1 year. He experienced dull pain and a sensation of fullness over the whole abdomen. The symptoms did not improve after conservative treatment. The presumptive diagnosis was intestinal obstruction, and an exploratory laparotomy found diverticulosis of the proximal jejunum, with an adhesion band formed from the base of one diverticulum. Strangulation of a segment of the jejunum resulted from the internal herniation caused by the band. The band was removed and the proximal jejunum segmentally resected. His postoperative course was uneventful.     

Enteric neuropathology of congenital intestinal obstruction： A case report

Experimental evidence indicates that chronic mechanical sub-occlusion of the intestine may damage the enteric nervous system (ENS),although data in humans are lacking. We here describe the first case of enteric degenerative neuropathy related to a congenital obstruction of the gut. A 3-year and 9-mo old girl began to complain of vomiting, abdominal distension, constipation with air-fluid levels at plane abdominal radiology. Her subsequent medical history was characterized by 3 operations: the first showed dilated duodeno-jejunal loops in the absence of occlusive lesions; the second (2 years later) was performed to obtain full-thickness biopsies of the dilated intestinal loops and revealed hyperganglionosis at histopathology; the third (9 years after the hyperganglionosis was identified) disclosed a Ladd's band which was removed and the associated gut malrotation was corrected. Repeated intraoperative full-thickness biopsies showed enteric degenerative neuropathy along with reduced interstitial cells of Cajal network in dilated loops above the obstruction and a normal neuromuscular layer below the Ladd's band. One year after the latest surgery the patient tolerated oral feeding and did well, suggesting that congenital (partial) mechanical obstruction of the small bowel in humans can evoke progressive adaptive changes of the ENS which are similar to those found in animal models of intestinal mechanical occlusion. Such ENS changes mimic neuronal abnormalities observed in intestinal pseudoobstruction.     

Idiopathic abdominal cocoon syndrome with unilateral abdominal cryptorchidism and greater omentum hypoplasia in a young case of small bowel obstruction

Abdominal cocoon syndrome (ACS) is a rare cause of intestinal obstruction due to total or partial encapsulation of the small intestine by a fibrocollagenous membrane. Idiopathic ACS with abdominal cryptorchidism and greater omentum hypoplasia is even rarer clinically. We successfully treated a 26-year-old male case of small bowel obstruction with acute peritonitis. He was finally diagnosed with idiopathic ACS with unilateral abdominal cryptorchidism and greater omentum hypoplasia during exploratory laparotomy. He then underwent enterolysis, cryptorchidectomy, and appendectomy. He recovered gradually from the operations and early postoperative inflammatory ileus. There has been no recurrence of intestinal obstruction since the operation, and he is still in follow-up. We analyzed his clinical data and retrospectively reviewed the literature, and our findings may be helpful for the clinical diagnosis and treatment on ACS.     

'Sandwich' treatment for diospyrobezoar intestinal obstruction: A case report

Intestinal obstruction is a common clinical entity encountered in surgical practice. The objective of this report is to corroborate an atypical scenario of intestinal obstruction in a Chinese patient and to focus on the diagnosis and treatment. A 27-year-old male presented with a history of gastric pain combined with nausea and abdominal distension that had been present for 5 d. The presence of a foreign body was detected by computed tomography and observed as an abnormal density within the stomach. A diospyrobezoar was revealed during gastroscopy, the extraction of which was prevented due to its size and firmness. An endoscopic holmium laser joined with a snare was used to fragment the obstruction, which was followed by management with a conservative “sandwich” treatment strategy involving intestinal decompression with an ileus tube and Coca-Cola lavage between endoscopic lithotripsy fragmentation procedures. This strategy resulted in the successful removal of the diospyrobezoar along with multiple small bowel obstructions. The patient was discharged after abatement of symptoms. The case presented here demonstrates the implementation of a conservative, yet successful, treatment as an alternative to conventional surgical removal of intestinal obstructions.     

回肠末端弥漫性大B细胞淋巴瘤并肠梗阻1例报道

原发性肠道淋巴瘤临床很少见,易误诊。     

A case of intestinal obstruction following stent graft placement for an abdominal aortic aneurysm.

A 76-year-old male was admitted to hospital complaining of severe abdominal pain, constipation, nausea and vomiting. The patient had undergone stent graft placement of an abdominal aortic aneurysm (AAA) at another hospital 13 months prior to admission. An X-ray, computed tomography scan and barium-enema examination revealed partial obstruction of the duodenum. Stent graft placement has been reported to be a useful procedure for AAA. However, as mass effects associated with AAA cannot be excluded, several symptoms may remain postoperatively.     

Small intestinal obstruction resulting from ischemic enteritis: a case report

A 69-year-old male was admitted to our institution because of a sudden onset of vomiting and abdominal distention. His past history of illness included femoral head fracture, congestive heart failure and ischaemic colitis. Plain abdominal computed tomography revealed extensively dilated small intestinal loops with a calibre change around the end of the ileum. Small intestinal obstruction was diagnosed and a transnasal ileus tube was placed. The ileus tube was constantly moved towards small intestine until it reached the distal ileum. Contrast medium from the ileus tube revealed a distal ileal stricture. Subsequently, transanal single balloon enteroscopy was performed to inspect the stricture, revealing a circumferential and afferent tubular ulcer in the distal ileum, 5 cm from the ileocecal valve; gastrofluorography confirmed the stricture. Although the stricture was dilated on several occasions using balloon catheters, the stricture could not be improved. However, during the treatment, his general condition worsened over time; thus, surgical treatment was decided. Operative findings revealed several circumferential ulcers with a clear margin 5–28 cm from the ileocecal valve: all lesions were successfully resected. Pathological findings were consistent with ischaemic enteritis. We report a case of small intestinal obstruction resulting from stenotic ischaemic enteritis.