Idiopathic sclerosing encapsulating peritonitis （or abdominal cocoon）： A report of 5 cases

Sclerosing encapsulating peritonitis （SEP） is a rare cause of intestinal obstruction that is characterized by a thick grayish-white fibrotic membrane encasing the small bowel. SEP can be classified as idiopathic, also known as abdominal cocoon, or secondary. It is difficult to make a definite pre-operative diagnosis. We experienced five cases of abdominal cocoon, and the case files were reviewed retrospectively for the clinical presentation, operative findings and outcome. All the patients presented with acute, subacute and chronic intestinal obstruction. Computed tomography （CT） showed characteristic findings of small bowel loops congregated to the center of the abdomen encased by a soft-tissue density mantle in four cases. Four cases had an uneventful post-operative period, one case received second adhesiolysis due to persistent ileus. The imaging techniques may facilitate pre-operative diagnosis. Surgery is important in the management of SEP.     

腹茧症的特点及诊治方法探讨（附7例报告）

为提高对腹茧症的认识临床诊治水平,分析了16年来经治的7例腹茧症患者的临床资料,结果临床表现为腹痛7例,腹胀4例,腹部包块2例,术前均示明确诊断,分别误诊为卵巢肿瘤蒂扭转2例,急性弥漫性腹膜炎1例,慢性阑尾炎1例,急、慢性肠梗阻3例。术中发现大网膜短缩3例、缺如4例,全部或部分小肠被一层灰白色致密坚韧的纤维膜包裹。均行手术治疗,术后病理检查确诊为腹茧症。提示该病临床表现无特异性,术前诊断困难,需手术及病理确诊,以手术治疗为主。     

Malignant transformation in abdominal cryptorchid testis 40 years after treatment of seminoma confined to other testis

This report describes an exceptionally rare case of a 64-year-old man with seminoma in abdominal cryptorchidism, leading to intestinal obstruction 40 years after curative treatment for seminoma of the other (descended) testis.     

Intestinal obstruction due to migration of a thermometer from bladder to abdominal cavity: A case report

Intraperitoneal foreign bodies such as retained surgical instruments can cause intestinal obstruction. However, intestinal obstruction due to transmural migration of foreign bodies has rarely been reported. Here, we report a case of intestinal obstruction due to a clinical thermometer which migrated from the bladder into the abdominal cavity. A 45-year-old man was admitted to our hospital with a one-year history of recurrent lower abdominal cramps. Two days before admission, the abdominal cramps aggravated. Intestinal obstruction was confirmed with upright abdominal radiography and computerized tomography scan which showed dilation of the small intestines and a thermometer in the abdominal cavity. Then laparotomy was performed. A scar was observed at the fundus of the bladder and a thermometer was adhering to the small bowels and mesentery which resulted in intestinal obstruction. Abdominal cramps were eliminated and defecation and flatus recovered soon after removal of the thermometer.     

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.     

Continuous regional arterial infusion and laparotomic decompression for severe acute pancreatitis with abdominal compartment syndrome

AIM:To evaluate the therapeutic effects of abdominal decompression plus continuous regional arterial infusion(CRAI) via a drug delivery system(DDS) in severe acute pancreatitis(SAP) patients with abdominal compartment syndrome(ACS).METHODS:We presented our recent experience in 8 patients with SAP.The patients developed clinical ACS,which required abdominal decompression.During the operation,a DDS was inserted into the peripancreatic artery(the catheter was inserted from the right gastroepiploic artery until...     

Ileal stenosis occurred 3 months after blunt abdominal trauma

We present a case of ileal stenosis with delayed presentation 3 months after car accident. Ileal stenosis after blunt abdominal trauma is a rare clinical entity. We present CT and small bowel series 3 months after trauma. Image showed segmental thickening of intestinal wall and proximal bowel dilation. At surgery, a stenotic bowel loop was adjacent to a fibrotic mesentery. Histological examination showed ulcers, inflammatory cells and fibroblasts infiltrated to the muscularis mucosae, submucosa, and mesentery. The most likely cause, supported by most authors, implicates an injury to the mesentery. Post-traumatic ischemic bowel stenosis may result from even small tears and contusions of mesentery. Posttraumatic intestinal stenosis should be included in the differential diagnosis in a patient with a history of blunt abdominal trauma and signs of intestinal obstruction.     

Large-bowel obstruction as a late sequela of retrosternal diaphragmatic hernia

A 37-year-old man with a past history of a fall from height 16 years previously was admitted with acute abdomen. Investigations revealed intestinal obstruction caused by a diaphragmatic hernia. He had an incarcerated omentum and Richter's hernia of the transverse colon secondary to left diaphragmatic hernia leading to colonic ileus. Following resection of the strangulated omentum and reduction of the colon intraabdominally, a surgical repair of the hernia was performed using an abdominal and transthoracic approach. The relatively rare late complication of a left-sided enterothorax with ileus makes this a remarkable case and underlines the need for early surgery to avoid late complications.     

Idiopathic sclerosing encapsulating peritonitis: abdominal cocoon

Abdominal cocoon, the idiopathic form of sclerosing encapsulating peritonitis, is a rare condition of unknown etiology that results in an intestinal obstruction due to total or partial encapsulation of the small bowel by a fibrocollagenous membrane. Preoperative diagnosis requires a high index of clinical suspicion. The early clinical features are nonspecific, are often not recognized and it is difficult to make a definite pre-operative diagnosis. Clinical suspicion may be generated by the recurrent episodes of small intestinal obstruction combined with relevant imaging findings and lack of other plausible etiologies. The radiological diagnosis of abdominal cocoon may now be confidently made on computed tomography scan. Surgery is important in the management of this disease. Careful dissection and excision of the thick sac with the release of the small intestine leads to complete recovery in the vast majority of cases.     

Reconstruction of the abdominal wall by using a combination of the human acellular dermal matrix implant and an interpositional omentum flap after extensive tumor resection in patients with abdominal wall neoplasm： A preliminary result

AIM： To present our trial using a combination of the human acellular dermal matrix （HADM） implant and an interpositional omentum flap to repair giant abdominal wall defects after extensive tumor resection.
METHODS： Between February and October of 2007, three patients with giant defects of the abdominal wall after extensive tumor resection underwent reconstruction with a combination of HADN and omentum flap. Postoperative morbidities and signs of herniation were monitored.
RESULTS： The abdominal wall reconstruction was successful in these three patients, there was no severe morbidity and no signs of herniation in the follow-up period.
CONCLUSION： The combination of HADM and omentum flap offers a new, safe and effective alternative to traditional forms in the repair of giant abdominal wall defects. Further analysis of the long-term outcome and more cases are needed to assess the reliability of this technique.     

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.     

Left-sided omental torsion with inguinal hernia

We report a case of surgically proved left-sided torsionof the greater omentum that caused secondary byuntreated inguinal hernia.Case A 36-year-old manpresented to our hospital with abdominal pain.Hehad been diagnosed with a left inguinal hernia,but hehad not received any treatments.Contrast-enhancedcomputed tomography(CT)of the abdomen showeda large fat density mass below the Sigmoid colon andleft inguinal hernia with incarcerated fat.Exploratorylaparotomy revealed torsion of the greater omentumwith small bloody ascites.The greater omentum wastwisted into one and a half circles and entered into a leftinguinal hernia.An omentectomy with a repair of leftinguinal hernia was performed.A resected omentum wassubmitted for pathological examination,which showedhemorrhagic infarction.Omental torsion is a rare causeof acute abdominal pain but should be included in thedifferential diagnoses of acute abdomen,especially inpatients with untreated inguinal hernia.     

Factors influencing the development of small intestinal obstruction following gastrectomy for early gastric cancer

BACKGROUND/AIMS: The factors influencing the development of small intestinal obstruction following gastrectomy for early gastric cancer are controversial. METHODOLOGY: Univariate and multivariate analyses were carried out using data from 136 patients with early gastric cancer who underwent gastrectomy. The mean follow-up interval was 5 years and 11 months. RESULTS: Of these 136 patients, 15(11.0%) presented mechanical obstruction in the small intestine postoperatively. Re-operation for repair of the related ileus was required in 8 patients, 4 of whom had been treated with total gastrectomy, 7 with resection of the greater omentum, and 3 with concomitant resection of other organs. Development of an obstruction was not related to wide resectional procedures such as extended lymph node dissection or combined resection of other organs, but was significantly correlated with total gastrectomy and resection of the greater omentum (p < 0.05). In multivariate logistic regression analysis, total gastrectomy proved to be a significant risk factor related to the development of small intestinal obstruction. CONCLUSIONS: In patients with early gastric cancer, total gastrectomy should not be attempted to prevent postoperative ileus and to ensure a fairly sustained quality of life.     

不明原因腹痛患者胶囊内镜检查的应用分析

目的探讨胶囊内镜在诊断不明原因腹痛的临床价值及安全性。方法将本院73例不明原因腹痛患者进行胶囊内镜检查,对检查结果进行分析。结果 73例患者中50例被检出小肠病变,检出率为68.49%。其中小肠克罗恩病6例、回肠多发性溃疡2例、小肠多发性毛细血管扩张1例、小肠息肉4例、小肠肿瘤1例、小肠寄生虫2例、小肠黏膜糜烂22例。12例分别为慢性浅表性胃炎、结肠炎、十二指肠溃疡。23例检查无异常。结论胶囊内镜操作简单、安全性高,对不明原因腹痛有较高的诊断价值。     

Partial intestinal obstruction secondary to multiple lipomas within jejunal duplication cyst: A case report

Lipoma within jejunal duplication presenting as abdominal bloating and partial intestinal obstruction is an exceptional clinical entity.We report a case of 68-year-old man complaining of abdominal bloating for 10 d due to multiple lipomas arising from jejunal duplication cysts.Only a few cases of a single lipoma within a Meckel’s diverticulum giving rise to this clinical scenario have been reported in the English language literature.However,no case of multiple lipomas within jejunal duplication cysts has be...     

Diagnostic dilemma of abdominal tuberculosis in non-HIV patients： An ongoing challenge for physicians

INTRODUCTION In developing countries, tuberculosis is associated with poverty, deprivation, overcrowding, illiteracy, and limited access to health care facilities. While in developed worlds, tuberculosis is commonly accompanied with HIV infection, ageing …     

Coarctation of the abdominal aorta. Treatment by stent placement]

We report a nine-year-old boy referred for evaluation of suspected coarctation of the aorta. He presented with hypertension and absent femoral pulses. A 50 mmHg gradient was detected in the abdominal aorta by color flow doppler echocardiography but the level of coarctation was impossible to locate. The diagnosis was made by magnetic resonance imaging and aortography, showing segmentary hypoplasia in the upper abdominal segment of the descending aorta, immediately below the celiac axis and above the renal arteries.Treatment consisted in placement of a stent Palmaz, which was effective in significantly decreasing the gradient. Some clinical aspects and different therapeutic strategies for this unusual case are discussed.     

Pseudopneumoperitoneum in chronic intestinal pseudo-obstruction: a case report

Chronic intestinal pseudo-obstruction(CIPO) is a rare disease due to a severe gastrointestinal motility disorder which may mimic,on both clinical and radiological grounds,mechanical obstruction.We report a case of a 26-year-old woman who presented to our institution for plain abdominal radiography for referred long-lasting constipation with recurrent episodes of abdominal pain and distension.At X-ray,performed both in the upright and supine position,an isolated air-fluid level was depicted in the left flank...     

Case series of acute presentation of abdominal TB in Ghana

We report on a six-year prospective study to determine the presentation and outcome of acute abdominal TB at Komfo Anokye Teaching Hospital. Between January 1998 and December 2003, material for biopsy including resected bowel was taken from all cases of acute abdomen, which at laparotomy were suspected as one or other form of abdominal TB. TB-positive cases were then retrospectively analysed for clinical presentation and outcome of surgical treatment. There were 96 histologically proven cases of abdominal TB, 60 in women and 36 in men. Seventy patients (72.9%) were admitted as acute intestinal obstruction with acute abdominal pain, vomiting, constipation, distension and fluid levels on abdominal X-ray. Twenty-two (22.9%) patients were admitted as acute diffused peritonitis - with generalized abdominal tenderness, guarding and rebound - and four (4.2%) as acute appendicitis. There were 74 emergency bowel resections (77% resection rate) for 34 ileocaecal masses, 16 strictures, 10 perforations and 14 adhesions, with a mortality of 4.2%. Previous series from our subregion have reported similar emergency resection mortality rates for other abdominal conditions. All the patients received postoperative anti-TB therapy. This paper notes that acute intestinal obstruction is the most common acute presentation of abdominal TB in our environment. The results of emergency resection compare favourably with resection for other acute abdominal conditions.     

Meckel's diverticulum incarcerated in a transmesocolic internal hernia

Intestinal obstruction is a common complication associated with Meckel’s diverticulum in adults. The diverticulum itself or its fibrous band can lead to an intestinal volvulus, intussusceptions, or closed-loop obstructions, which require surgery. The incarceration of Meckel’s diverticulum in either inguinal or femoral hernia sacs (Littre’s hernia) is another, less common, etiology underlying intestinal obstruction. This case report describes a 45-year-old man who had an obstruction associated with a Meckel’s diverticulum that passed through a congenital defect in the mesocolon into the right subphrenic space. The patient, who had not undergone abdominal surgery previously, came to the emergency room with acute onset of intermittent epigastric pain and abdominal distention. Computed tomography images showed the presence of a segment of the small bowel and a diverticulum in the right subphrenic space and paracolic gutter. The twisted mesentery and the dilated loops of the proximal small bowel were indicative of an intestinal volvulus and obstruction. Meckel’s diverticulum complicated by a transmesocolic internal hernia was diagnosed, and this condition was confirmed during emergency surgery. The patient’s postoperative recovery was uneventful. This case report highlights another presentation of Meckel’s diverticulum, that is, in combination with a transmesocolic internal hernia. This etiology may lead to an intestinal volvulus and necessitate early surgery.