腹茧症的外科治疗

目的探讨腹茧症的诊断及治疗. 方法回顾性总结6例腹茧症的临床资料. 结果 6例腹茧症患者术前均误诊,5例诊为肠梗阻,1例诊为腹部包块,6例均给予全部或部分包膜切除术,1例行肠排列术. 结论腹茧症临床表现无特异性,术前诊断困难.上消化道造影、B超及CT对诊断有帮助.治疗常选择行全部或部分包膜切除、肠排列、肠切除、粘连松解术.     

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腹茧症是一种罕见的腹部疾病,病因不明,以腹腔部分或全部脏器被一层纤维膜包裹为其特征,包裹内容物以小肠最为常见,形似蚕茧。本病术前诊断困难,常以肠梗阻或腹部包块为首发症状,治疗原则以手术为主。对于因肠梗阻而就诊的病例应充分松解粘连,解决肠梗阻问题;对无症状的病例,在     

腹茧症诊治体会

目的 探讨腹茧症的特征和诊治方法.方法 回顾我院1997年3月至2005年3月收治的5例腹茧症患者的临床资料,结合文献报道,就该病特点及诊治经验进行探讨.结果 本组病例2例曾有腹部手术史,4例表现为急、慢性不完全性肠梗阻,1例因胆总管结石,术中明确诊断;所有病例均行手术治疗,术中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,术后全部治愈出院.结论 腹茧症是一种较为少见的疾病,当遇到无法解释的急、慢性肠梗阻患者时,应考虑本病可能;放射学检查能协助诊断,手术发现全部或部分小肠为一层致密、灰白色质韧、硬厚的纤维膜所包裹则能确诊;手术是首选治疗方法.     

腹茧症并发肠梗阻三例报告

腹茧症是一种临床上罕见的腹部疾患,由Foo[1]首次命名。该病的特点为全部或部分小肠被一层致密、灰白色、质韧、硬厚的纤维膜所包裹。由于其临床表现无特异性,不易作出明确诊断。该病往往以肠梗阻为主要临床表现,术前不能明确诊断,术后可能再次出现肠梗阻表现。近年来,该病不断有报道。我院2002年~2004 年诊治腹茧症并发肠梗阻3例,现报告如下。临床资料1.一般资料:本组共3例,其中,男性2例,女性1例;年龄37~50岁,平均年龄 43 岁。主要表现为消化道症状,腹痛、腹胀,肛门停止排气、排便 3 例;腹水2例;腹部包块2例;消瘦1例。术前诊断为慢性…     

腹茧症1例报告并文献复习

腹茧症（abdominal cocoon）是一种罕见的腹部疾患,由Foo等于1978年首先报道并命名。本病原因不明,是一种特殊类型的肠梗阻,以小肠全部或部分小肠被茧状包裹在一层异常的纤维膜内为特征,腹痛,腹部包块和肠梗阻为其特点。此前,由于该病的特点为全部或部分小肠被一层致密灰白色、质韧硬厚的纤维所包裹,因此各家命名不同,如局限性小肠系膜包绕症,特发性硬化性腹膜炎,小肠茧状包裹症。目前,腹茧症之名为众家所接受。     

腹茧症的诊治体会（附9例报道）

目的 提高对腹茧症的认识和临床诊治水平.方法 回顾性分析我院1995～2008年期间收治的9例腹茧症患者的临床资料.结果 9例患者中5例以急、慢性肠梗阻症状为主要表现,结合CT、彩超、腹部X线平片等检查,2例术前诊断为腹茧症.9例患者经手术治疗后均获得成功.8例得到随访,随访时间6～84个月,平均(26±13)个月,2例分别于术后3及10个月出现肠梗阻,经保守治疗后治愈,其余无相关手术并发症发生.结论 患者反复有肠梗阻表现而梗阻原因不明或出现腹部包块,需结合合理的影像学检查考虑腹茧症的可能;手术是本病诊断和治疗的有效手段.     

腹茧症5 例的临床诊治效果

目的:探讨原发性腹茧症的临床表现、影像学表现及诊治经验。方法:回顾性分析我院2019 年3 月17 日—2020年11 月9 日诊治的5 例腹茧症患者资料，包括临床症状、影像学表现、手术方法和术后并发症及术后近、远期效果等情况。结果:5 例患者临床表现均为肠梗阻，其中2 例患者术前CT 检查可见小肠外有纤维膜包裹而高度怀疑腹茧症。5 例均接受手术，术后2 例发生并发症均为早期肠梗阻，1 例失访，术后近、远期随访中出现1 例下腹痛病例，其余患者恢复良好。结论:腹茧症多以肠梗阻为主要临床症状，缺乏特异性，术前诊断较困难。腹部CT 检查伴冠矢状重建对其诊断具有重要价值，手术是主要治疗方法，总体预后较满意。     

腹茧症的诊断与治疗

本研究探讨腹茧症的影像学特征以及外科手术治疗的操作要点。回顾性总结12例腹茧症患者资料,分析其临床特征、CT和X线钡餐透视检查资料以及手术治疗方式。腹茧症患者的CT征象为可延迟增强的包裹小肠纤维包膜,X线钡餐透视示造影剂长时间不能排空。手术探查发现患者小肠全部或部分被一层灰白色、质密的纤维膜包裹。消化道X线钡餐造影和腹部CT检查对于原发性腹茧症患者的术前诊断具有重要价值,而手术是最有效的治疗方法。     

腹茧症一例报告

腹茧症是一种较少见的疾病。术前诊断困难 ,病因不明 ,命名多样 (局限性肠外膜包绕症、先天性小肠禁箍症、特发性硬化腹膜炎、小肠茧状包裹症、小肠节段性纤维包裹症、Brown -Windsor小肠茧状包裹症、包裹内粘连性肠梗阻等 )。现将我院收治的一例腹茧症报告如下 :　　患者男性 ,60岁 ,因腹胀、纳差 2个月 ,反酸、呕吐一周入院。无长期服药史 ,无腹部手术史。查体 :腹部平、软 ,于中腹触及一巨大肿物 ,界不清 ,无压痛 ,肠鸣音活跃。腹部透视见右上腹液气平面。钡餐检查见钡剂在小肠通过缓慢。B超探及少量腹水。CT示局部肠管明显变细、僵硬 …     

腹茧症(文献综述)

腹茧症首由1978年被正式命名，迄今文献报道仅57例。其特点是全部或部分小肠被一层灰白色质韧厚硬的纤维膜包裹，病因不明。临床以腹部包块或肠梗阻为首发症状，手术松解是有效手段。     

原发性腹茧症16例的诊断与外科治疗

目的提高对腹茧症的术前诊断率，进行合理的外科治疗。方法分析1993年6月至2006年10月四川大学华西医院普通外科收治的16例腹茧症患者的临床资料。结果术前8例经钡剂造影显示受累小肠管形成“扭麻花”状；钡柱前端前进方向呈“M”形；6例显示为不完全性小肠梗阻：2例肠管排空时间延长。CT检查显示肠管扩张、其周围可见一层膜状物。手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，其中包裹部分小肠（I型）1例；包裹全部小肠（Ⅱ型）2例；包裹全部小肠及其他脏器（Ⅲ型）12例。全组行粘连松解术，2例行小肠排列术．1例慢性幽门梗阻患者行胃造口术。1例在剥离、切除包裹膜的同时行直肠癌根治术，合并回肠克罗恩病的患者同时进行部分回肠结肠吻合术，但术后10d再次出现小肠瘘，予以保守治疗而愈。全部治愈出院。病理诊断均为小肠浆膜面纤维结缔组织。结论腹茧症术前诊断主要依靠钡剂造影和CT．手术应彻底切除包膜、松解粘连及预防小肠梗阻。     

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.     

Meckel’s cocoon: A rare case of abdominal cocoon with Meckel’s diverticulum

Abdominal cocoon syndrome (ACS), also known as sclerosing encapsulating peritonitis, is a rare cause of intestinal obstruction in which there is partial or total encapsulation of abdominal viscera within a dense fibrous membrane. It was first described by Foo et al. [1] in 1978. This condition was thought to be related to retrograde menstruation. However, sporadic cases have been reported in both children and men, hence the exact aetiology remains unknown. This disease is characterized as either primary (idiopathic) or secondary to other causes. It is often confused with peritoneal encapsulation (PE) which is a congenital anomaly. It invariably presents as an acute or subacute intestinal obstruction with or without a mass. Diagnosis is mostly made after exploratory laparotomy and histopathological analysis of the sac. Herein, we present the case of a 38-year-old male who presented with features of acute intestinal obstruction. At laparotomy, small bowel loops were found encased in a cocoon with a tight ring at the base which resulted in bowel wall necrosis; Meckel’s diverticulum was also present within the cocoon. Resection of the cocoon and anastomosis was performed. A better awareness of these conditions will facilitate proper management when encountered as an emergency.     

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.     

An association between transmesenteric internal hernia and abdominal cocoon syndrome: A case report

IntroductionTransmesenteric internal hernia is defined as the herniation of the small intestine from a mesenteric defect in the abdominal cavity, and abdominal cocoon syndrome is the partial or entire encapsulation of the small bowel like the shape of an accordion, by a fibrocollagenous membrane.Presentation of caseA 32-year old male patient applied with complaints of abdominal pain, nausea, and vomiting bile. Signs visualized in the abdominal computer tomography were as follows: gatto formation of the small intestinal loops and suspected of an internal hernia.In the operation, a membrane was detected encapsulating the entire intestine resembling a tube, making the intestines to appear like an accordion and an opening was present in the small intestinal mesentery. The intestine was separated from the defect, and placed in its normal anatomical position. The defect in the mesentery was closed and the encapsulating membrane was removed from small intestine. Intestinal resection was not required.DiscussionInternal hernias comprise less than 1% of all intestinal obstructions, and are formed by the herniation of the intestine and mesentery into the opening of the visceral peritoneum or into the recessus. Abdominal cocoon syndrome is a disorder characterized by the partial or total encapsulation of the small intestine by a thick and fibrotic membrane. Preoperative diagnosis is very difficult and is generally diagnosed during laparotomy exploration.ConclusionThe association of internal herniation and abdominal cocoon syndrome is an extremely rare cause of mechanical intestinal obstruction. If not promptly diagnosed and treated, can lead to serious complications.     

Diagnosis and treatment of abdominal cocoon: a report of 24 cases

Background

Abdominal cocoon (AC) is a rare disease characterized by total or partial encasement of the small bowel by a thick, fibrous membrane. Twenty-four cases are reported in this article. Our aim was to investigate the methods of diagnosis and treatment for AC.

Methods

The clinical manifestations, diagnoses, surgical treatments, and follow-up results of 24 cases of AC in the Department of General Surgery of the Third Affiliated Hospital of Sun Yat-sen University between January 1997 and September 2007 were retrospectively analyzed.

Results

Main clinical manifestations were partial or complete intestinal obstruction (87.5%) and abdominal mass (54.2%). Three cases were preoperatively diagnosed by computed axial tomography and 1 case by barium x-ray examination. The other 20 cases were diagnosed by laparotomy. All of the patients underwent surgery. In all cases, we found that part of or the entire small bowel was encapsulated in a dense, white, fibrous, cocoon-like membrane. During surgery, excision of the thick membrane and lysis of adhesions were carefully performed to release the small intestine. Postsurgical recovery in most cases was smooth, and there was no recurrence during a follow-up period of 3 months to 9 years (mean 37 months).

Conclusion

The clinical manifestation of AC is nonspecific; therefore, preoperative diagnosis is difficult. However, its manifestations on barium x-ray and contrast computed axial tomography scan are characteristic, and aggregate analysis of the clinic and radiologic data can increase preoperative diagnosis. The main treatment of AC is surgery, and the overall prognosis of these patients is satisfactory.     

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。     

Abdominal Cocoon Syndrome: a Rare Cause for Recurrent Abdominal Pain

Abdominal cocoon syndrome, or sclerosing peritonitis, is a rare condition characterized by encasement of small bowel loops by a thick fibrous scar. It most commonly presents as nonspecific vague chronic abdominal pain and weight loss, and is difficult to recognize clinically until the patient develops symptoms of bowel obstruction. We present a case of abdominal cocoon syndrome in a 65-year-old female and describe its clinical, imaging, and pathologic features.     

An unusual and difficult diagnosis of intestinal obstruction: The abdominal cocoon. Case report and review of the literature

Abdominal cocoon is a rare cause of intestinal obstruction. The abdominal cocoon is probably a developmental abnormality, largely asymptomatic, and is found incidentally at laparotomy or autopsy. Pre-operative diagnosis cannot be often made correctly. This rare entity of intestinal obstruction has been described in the whole literature as a thick fibrotic sac covering the small bowel partially or completely. The etiology of abdominal cocoon is unknown and most often it is found in adolescent girls from tropical or subtropical countries. Complete recovery is generally expected after the removal of the membrane surgically. This paper reports a male patient who has had intestinal obstruction symptoms and has per-operatively been diagnosed as abdominal cocoon.