Abdominal cocoon: Report of a case

The abdominal cocoon is a rare cause of intestinal obstruction most often found in adolescent girls from tropical and subtropical countries. It is characterized by a thick fibrotic sac covering the small bowel partially or completely, the etiology of which is unknown. A correct diagnosis is not often made preoperatively; however, following simple surgical release of the entrapped bowel, these patients usually do well. We report herein our experience of a case of abdominal cocoon with a brief review of the medical literature on this unusual disease entity. Received: May 26, 1999 / Accepted: May 30, 2000     

Abdominal cocoon—A rare cause of intestinal obstruction

INTRODUCTIONAbdominal cocoon syndrome is characterized by small bowel encapsulation by a fibro-collagenous membrane or “cocoon”. It is a rare cause of intestinal obstruction.PRESENTATION OF CASEA 42-year old man presented with sub-acute intestinal obstruction. Intra-operatively, the entire small bowel was found to be encapsulated in a dense fibrous sac. The peritoneal sac was excised, followed by lysis of the inter-loop adhesions. Postoperative recovery was unremarkable.DISCUSSIONMost patients with abdominal cocoon syndrome present with features of recurrent acute or chronic small bowel obstruction secondary to kinking and/or compression of the intestines within the constricting cocoon. An abdominal mass may also be present due to an encapsulated cluster of dilated small bowel loops.CONCLUSIONAbdominal cocoon is a rare condition causing intestinal obstruction and diagnosis requires a high index of suspicion because of the nonspecific clinical picture. CECT of the abdomen is a useful radiological tool to aid in preoperative diagnosis. Peritoneal sac excision and adhesiolysis is the treatment and the outcome is usually satisfactory.     

腹茧症的影像学表现

腹茧症(AC)是一种少见的腹部综合征,表现为部分或全部小肠被一层厚纤维膜覆盖、包绕所致的肠梗阻或软组织包块.本文对其命名、病因、临床及影像学表现进行综述.     

A rare cause of small bowel obstruction due to bezoar in a virgin abdomen

IntroductionBezoar is an unusual cause of small bowel obstruction accounting for 0.4–4% of all mechanical bowel obstruction. The common site of obstruction is terminal ileum.Case reportA 28-year-old male with no past surgical history, known to have severe mental retardation presented with anorexia. CT scan demonstrated dilated small bowel loops and intraluminal ileal mass with mottled appearance. At exploratory laparotomy, a bezoar was found impacted in the terminal ileum 5–6 inches away from the ileocecal valve and was removed through an enterotomy.DiscussionBezoars are concretions of fibers or foreign bodies in the alimentary tract. Small bowel obstruction is one of common clinical symptoms. The typical finding of well-defined intraluminal mass with mottled gas pattern in CT scan is suggestive of an intestinal bezoar. The treatment option of bezoar is surgery including manual fragmentation of bezoar and pushing it toward cecum, enterotomy or segmental bowel resection. Thorough exploration of abdominal cavity should be done to exclude the presence of concomitant bezoars. Recurrence is common unless underlying predisposing condition is corrected.ConclusionsBezoar-induced small bowel obstruction remains an uncommon diagnosis. It should be suspected in patients with an increased risk of bezoar formation, such as in the presence of previous gastric surgery, a history suggestive of increased fiber intake, or patient with psychiatric disorders. CT scan is helpful for preoperative diagnosis.     

原发性腹茧症的诊断与治疗

目的 探讨腹茧症临床特点及诊治方法。方法分析2000年7月-2004年2月收治的9例腹茧症患者的临床资料。结果9例中8例表现为急、慢性肠梗阻的症状。5例有腹部包块。9例患者中8例术前进行了腹部X线平片、CT检查,均发现不全性肠梗阻。4例CT发现腹膜及肠管管壁增厚强化,肠壁间粘连紧密;4例CT发现腹腔内小肠径路紊乱,聚集成团,似可见增厚的包膜包裹。3例进行了消化道钡餐检查,其中1例无异常,1例不全性肠梗阻,1例小肠集中于中腹部。剖腹术中均发现全部或部分小肠被一层灰白色致密坚韧的纤维膜包裹。行粘连松解、肠排列术等,术后9例全部治愈。结论患者反复出现急性或慢性肠梗阻症状,而又无其他原因解释或合并腹部包块者,应考虑腹茧症的可能。术前放射学检查对本病的诊断很有价值。手术是主要的治疗方法。     

肠外排列术治疗腹茧症5例临床分析

目的探讨肠外排列术治疗腹茧症的临床效果与预后。 方法回顾性纳入自2013年收治的5例腹茧症行肠外排列术的临床资料,总结其病例特征、手术经过与临床转归。 结果5例患者中男性3例、女性2例,平均年龄59.8岁,3例具有既往腹部手术史;肠外排列术的平均时间为367.0 min、平均出血760 ml;3例行部分小肠切除术,平均切除长度21.3 cm;术后平均第14.8天开放流质饮食;术后平均住院天数22 d;所有患者均康复出院;随访45.2个月期间无患者因肠梗阻再次住院,临床疗效满意。 结论肠外排列术治疗腹茧症的安全性与有效性均较好,可作为腹茧症的主要治疗手段之一。     

腹茧症203例综合分析

目的探讨腹茧症的临床特点及诊治方法。方法综合分析203例腹茧症患者的临床资料，其中我院7例，国内文献报道196例。结果患者男：女为1．2：1，平均年龄33岁。临床表现以急、慢性肠梗阻为主者147例（72．4％），腹部包块53例（26．1％）。术前检查包括X线腹部拍片163例，B超85例，CT68例，钡餐透视32例。术前6例（3．0％）诊断为腹茧症。所有病例均行手术治疗，其中纤维包膜切除、肠粘连松解172例（84．7％），同时小肠部分切除34例（16．7％）。同时阑尾切除5l例（25．1％）；单纯阑尾切除2l例（10．3％）。术后再次并发肠梗阻55例（27．1％），保守治愈37例。再手术18例。192例（94．6％）治愈，死亡11例（5．4％）。结论腹茧症术前诊断困难。有肠梗阻表现者宜行手术治疗。复发粘连性肠梗阻是术后主要并发症，慎再次手术。     

Phytobezoar in Meckel's diverticulum: A rare cause of small bowel obstruction

IntroductionMeckel's diverticulum (MD) is the prevailing anomaly of the gastrointestinal tract, found in about 2% of the population; it rarely gives rise to symptoms and its discovery is usually accidental. Phytobezoar is a concretion of poorly digested fruit and vegetable fibres that is found in the alimentary tract and rarely can be the cause of small intestinal obstruction. Herein we report a rare case of intestinal obstruction due to phytobezoar formation into a MD.Presentation of caseA 50 year-old patient, was admitted to author's institution with an history of abdominal pain, nausea and multiples episodes of vomiting. Plain X-ray showed dilated small-bowel loops. Computed tomography (CT) revealed jejunal loops with air-fluid levels. The patient underwent explorative laparotomy where we found a giant Meckel's diverticulum, filled by a phytobezoar that caused small bowel compression. We performed a segmental ileal, resection, containing the MD. The histological exam confirmed Meckel's diverticulum.DiscussionBowel obstruction due to a phytobezoar in a Meckel's diverticulum is rare: only 7 cases have been reported in literature. MD complications are rare and phytobezoar is one of them with only few cases described in literature.ConclusionThe conventional x rays studies were inconclusive whereas abdominal contrast enhanced CT led to a definitive diagnosis. Explorative laparotomy or laparoscopy is mandatory in these cases.     

Intestinal chondrolipoma: uncommon cause of bowel obstruction

A case of intestinal obstruction caused by jejunal chondrolipoma in an 11-year-old boy is presented. To the best of our knowledge, this seems to be the first report of chondrolipoma arising from the small bowel in English language literatures.     

Idiopathic Abdominal Cocoon: Report of a Case

The abdominal cocoon is a rare disease in which there is total or partial encapsulation of the small bowel by a fibrous membrane. A correct diagnosis is not often made pre-operatively. Awareness of this rare cause of surgical emergency may prevent delay in treatment and avoid unnecessary procedures for the patient, such as bowel resection. We report a patient diagnosed with abdominal cocoon who was subsequently treated.     

Abdominal cocoon syndrome as a rare cause of mechanical bowel obstruction: report of two cases

An abdominal cocoon is an extremely rare condition, and has been reported mainly in young adolescent women as a cause of small bowel obstruction. In these patients, the small bowel is encased in a fibrous sac called an abdominal cocoon. We hereby present two cases who were diagnosed only by laparotomy and their correlation with the literature. They both received early intervention, thus preventing the need for bowel resection. The pathology of both membranes showed inflammation.     

腹腔镜手术在腹茧症治疗中的安全性及可行性研究

目的探讨腹腔镜手术在腹茧症治疗中的安全性和有效性。 方法回顾性分析2016年1月至2019年11月期间在上海交通大学医学院附属第九人民医院就诊共计13例接受外科手术的腹茧症患者的临床资料。 结果13例患者的外科手术均顺利完成,其中8例腹腔镜手术、5例传统手术。所有患者因肠梗阻症状而就诊,均进行茧膜切除及肠粘连松解术。由于既往腹部手术史,5例采用传统手术方式。相较于传统手术,腹腔镜手术组的术中出血量减少[(116.3 ± 14.0)ml比(180.6 ± 24.9)ml,P< 0.05],手术时间缩短[(99.3 ± 8.7)min比(130.6 ± 7.5)min,P<0.05]。腹腔镜组与传统手术组分别出现4例、3例术后并发症(P> 0.05);术后肠梗阻分别3例、2例(P>0.05);术后住院时间(11.4 ± 3.5)d和(13.4 ± 5.2)d(P> 0.05)。13例患者术后病理均提示纤维性包膜。 结论腹腔镜手术对于既往无腹部手术史腹茧症治疗是安全、有效的。     

An undigested cherry tomato as a rare cause of small bowel obstruction

Small bowel obstruction due to undigested fibre from fruits and vegetables is a rare but known medical condition. We report a case of small bowel obstruction caused by a whole cherry tomato in a patient without a past medical history of abdominal surgery. A 66-year-old man presented to the emergency department complaining of lower abdominal pain with nausea and vomiting. His last bowel movement had occurred on the morning of presentation. He underwent abdominal computed tomography (CT), which showed a sudden change of diameter in the distal ileum with complete collapse of the proximal small bowel segment. Laparoscopy confirmed a small bowel obstruction with a transition point close to the ileocaecal valve. An enterotomy was performed and a completely undigested cherry tomato was retrieved. To our knowledge, this is the first reported case of a small bowel obstruction caused by a whole cherry tomato.     

Laparoscopic adhesiolysis for small bowel obstruction

BACKGROUND: Historically, laparotomy and open adhesiolysis have been the treatment for patients requiring surgery for small bowel obstruction. Laparoscopic adhesiolysis has not gained wide acceptance. The indications and outcomes of laparoscopic adhesiolysis for small bowel obstruction are not well established. The purpose of this paper is to review the literature on laparoscopic adhesiolysis for small bowel obstruction and to discuss patient selection, surgical technique, and outcomes. DATA SOURCES: Medline search from 1980 to 2002. CONCLUSIONS: Laparoscopic adhesiolysis has been shown to be safe and feasible in experienced hands. For selected patients, laparoscopic adhesiolysis offers the advantages of decreased length of stay, faster return to full activity, and decreased morbidity. Patient selection and surgical judgment appear to be the most important factors for a successful outcome.     

Infantile visceral myofibromatosis--a rare cause of neonatal intestinal obstruction

Infantile myofibromatosis (IM) is a rare cause of intestinal obstruction in the newborn. A neonate with generalized IM having multifocal intestinal lesions presenting with intestinal obstruction is reported here. Unique intraoperative pictures are provided. The presentation, management, and the prognosis of IM are discussed.     

Abdominal Cocoon: Clinical Presentation, Diagnosis, and Management

A 15-year-old girl presented with features suggestive of sub-acute intestinal obstruction (SAIO) with a palpable abdominal lump. Contrast-enhanced computed tomogram (CECT) abdomen revealed congregated small gut loops confined to a single area and encased in a thick membrane suggestive of abdominal cocoon. On laparotomy, a thick white membrane was found encasing most of the small gut. The cocoon was excised releasing the encased small bowel. The patient was relieved of her symptoms following surgery. Histopathology of excised cocoon membrane revealed granulomatous inflammation consistent with tuberculosis. The patient was discharged on ninth postoperative day with advice to take anti-tuberculosis drugs for 6 months. The possibility of abdominal cocoon should be considered in patients with SAIO and abdominal lump. Abdominal cocoon being a rare condition, CECT is useful in clinching the diagnosis and planning elective surgery in experienced hands.