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。     

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。     

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.     

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。     

腹茧症2例报告

腹茧症临床较少见。 1995～ 2 0 0 0年 4月 ,我们曾收治 2例。报告如下。例 1:男 ,2 3岁。因腹胀、腹痛 ,恶心、呕吐伴肛门停止排气、排便 8小时入院。以往有类似发作两次。查体 :腹饱满 ,可见肠型 ,全腹压痛、反跳痛 ,移动性浊音 (± ) ,肠鸣音弱。 X线腹透显示下腹部明显胀气 ,可见多个液平面。血白细胞 14.6× 10 9/ L,N0 .93,L0 .0 7。诊断 :肠梗阻、肠坏死 ?急症剖腹探查。术中见腹腔少量淡黄色渗液 ,腹膜下一层灰白色质地较硬的纤维膜包裹全部小肠 ,小肠与包裹之纤维膜粘连 ,大网膜缺如。腹腔内其他脏器正常。手术切除纤维膜 ,分离…     

绞窄性肠梗阻32例

目的探讨绞窄性肠梗阻的手术时机及抢救方法.方法对近6a来的32例绞窄性肠梗阻病例进行回顾性分析和总结.结果近6a共手术治疗各类肠梗阻318例,其中肠绞窄坏死32例,均进行了肠切除手术.治愈28例,中毒性休克死亡4例(12.5%).随访0.5 a～3 a,有12例因肠梗阻再次入院手术治疗.结论延误诊断,延误手术时机,术后抢救措施欠妥及手术操作粗暴等是导致患者死亡的重要原因.当出现腹痛剧烈、持续并渐进加剧;持续剧烈的呕吐;有明显的腹膜刺激症或有持续固定的局部压痛和反跳痛;腹部不对称性隆起;体温、脉搏、白细胞计数在观察下有逐渐上升趋势或早期休克;呕吐或自肛门排出血性液体为绞窄性肠梗阻的诊断指标.术后的抗休克治疗也是降低死亡率的关键.     

腹茧症合并机械性肠梗阻1例

腹茧症是一种罕见的腹部疾病,主要表现为腹腔部分或全部脏器被一层纤维膜包裹,包裹内容物以小肠最为常见.本病术前诊断较为困难,患者多无症状或有轻微的腹部不适、消化不良等,常因其他疾病手术或尸检中偶然发现.部分患者临床上常表现为腹痛、腹胀、恶心、呕吐,严重时可引起肠梗阻.     

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。     

腹腔镜手术治疗机械性肠梗阻的应用价值

目的:探讨腹腔镜在机械性肠梗阻手术治疗中的可行性与安全性.方法:应用腹腔镜技术为机械性肠梗阻30例患者实施了手术治疗,包括肠粘连18例、肠管内疝1例、肠扭转1例、小肠憩室导致肠套叠1例、小肠间质瘤3例、小肠癌1例、肠道炎症3例和结肠癌2例.结果:28例患者在腹腔镜下完成手术,其中完全腹腔镜手术17例,腹腔镜辅助手术11例.其余2例患者因腹腔内粘连严重中转开腹.成功进行腹腔镜手术的时间30-200 min,患者术后疼痛轻、肠道功能恢复快、术后排气时间1-2 d,无手术并发症的发生.平均术后住院时间5 d,经过4-32 mo随访,均无肠梗阻症状的发生.结论:腹腔镜技术治疗机械性肠梗阻是一种比较安全且有效的手术方法,能够减少术后腹腔内再粘连的形成.     

Abdominal cocoon syndrome: Rare cause of intestinal obstruction—Case report and systematic review of literature

Background:Abdominal cocoon or sclerosing encapsulating peritonitis is an uncommon condition in which the small bowel is completely or partially encased by a thick fibrotic membrane. Our study presents a case of sclerosing encapsulating peritonitis and conducts a literature review.Methods:A bibliographic research was conducted. Our research comprised 97 articles. Gender, age, symptoms, diagnostic procedures, and treatment were all included in the database of patient characteristics.Case presentation:A 51-year-old man complaining of a 2-day history of minor diffuse abdominal pain, loss of appetite, and constipation was presented in emergency department. Physical examination was indicative of intestinal obstruction. Laboratory tests were normal. Diffuse intraperitoneal fluid and dilated small intestinal loops were discovered on computed tomography (CT). An exploratory laparotomy was recommended, in which the sac membrane was removed and adhesiolysis was performed. He was discharged on the tenth postoperative day.Results:There were 240 cases of abdominal cocoon syndrome in total. In terms of gender, 151 of 240 (62.9%) were male and 89 of 240 (37%) were female. Ages between 20 and 40 are most affected. Symptoms include abdominal pain and obstruction signs. For the diagnosis of abdominal cocoon syndrome, CT may be the gold standard imaging method. The surgical operation was the treatment of choice in the vast majority of cases (96.7%). Only 69 of 239 patients (28.9%) were detected prior to surgery, and CT was applied in these cases.Conclusion:Abdominal cocoon is a rare condition marked by recurrent episodes of intestinal obstruction. Surgical therapy is the most effective treatment option.     

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.     

Role of conservative management in tubercular abdominal cocoon: a case series

Background

Sclerosing encapsulating peritonitis (Abdominal cocoon) is an uncommon cause of intestinal obstruction and tuberculosis is an important etiology. Appropriate management of this entity is still uncertain.

Methods

We did a retrospective analysis of patients with abdominal cocoon who were seen over a two year period at a tertiary care center in North India. We included patients with tubercular abdominal cocoon (TAC) who were managed primarily with antitubercular therapy in the present report. The diagnosis of TAC was made using combination of criteria (radiological or surgical findings of cocoon with evidence of tuberculosis in form of microbiological, histological or biochemical evidence). The clinical presentation, outcome and need for surgery for these patients were retrieved from the records of these cases maintained in a database.

Results

Of 18 patients with abdominal cocoon, 15 patients had underlying tuberculosis. The median age was 28 years (interquartile range 24) and 12 (80%) were males. Three patients had confirmed tuberculosis on basis of microbiological evidence. All had abdominal pain for 1–9 months, and 11 had intestinal obstruction. Twelve patients had positive Mantoux test, none had HIV. Pulmonary tuberculosis was noted in four patients, pleural in five, splenic and intestinal in two each, hepatic and mediastinal lymph-nodal in one each. Thirteen patients were started on usual 4-drug anti-tubercular therapy (ATT) while two cirrhotics needed modified ATT. Three patients were on steroids with ATT and all three improved. One patient was lost to follow up. Of the rest 14 patients, 2 underwent surgery, 1 at initial presentation while another after 4 months of ATT. Overall five patients developed intestinal obstruction while on ATT, one needed surgery and one died of liver failure while others improved with conservative means.

Conclusion

TAC can be managed conservatively in a subset of patients.

     

Diagnostic effect of capsule endoscopy in 31 cases of subacute small bowel obstruction

AIM： TO evaluate the effectiveness and safety of capsule endoscopy （CE） in patients with recurrent subacute small bowel obstruction.METHODS： The study was a retrospective analysis of 31 patients referred to hospital from January 2003 to August 2008 for the investigation of subacute small bowel obstruction, who underwent CE. The patients were aged 9-81 years, and all of them had undergone gastroscopy and colonoscopy previously. Some of them received abdominal computed tomography or small bowel follow-through.RESULTS： CE made a definitive diagnosis in 12 （38.7%） of 31 cases： four Crohn＇s disease （CD）, two carcinomas, one intestinal tuberculosis, one ischemic enteritis, one abdominal cocoon, one duplication of the intestine,one diverticulum and one ileal polypoid tumor. Capsule retention occurred in three （9.7%） of 31 patients, and was caused by CD （2） or tumor （1）. Two with retained capsules were retrieved at surgery, and the other one of the capsules was spontaneously passed the stricture by medical treatment in 6 too. No case had an acute small bowel obstruction caused by performance of CE.CONCLUSION： CE provided safe and effective visualization to identify the etiology of a subacute small bowel obstruction, especially in patients with suspected intestinal tumors or CD, which are not identified by routine examinations.     

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.     

Testicular torsion in undescended testes

A 17-year-old boy with spastic quadriplegia presented with a progressively enlarging, tender, right inguinal mass. Examination revealed absence of both testicles in the scrotal sac. The left testicle was palpable in the left superficial inguinal pouch. A diagnosis of an undescended right testicle was confirmed by exploratory surgery. Orchidectomy of the right testicle was performed and the remainder of the patient's course was uneventful. We present this case to describe the relationship between cryptorchidism, testicular torsion, and neuromuscular disease. Specific emphasis is placed on incidence, pathophysiological mechanisms, and treatment of testicular torsion in cryptorchidism.     

成人美克尔憩室所致急性肠梗阻的临床特点

目的 分析成人美克尔(Meckel)憩室所致急性肠梗阻的临床特点和诊治体会.方法 对9例美克尔憩室所致急性肠梗阻病例的临床资料和病理学特点进行回顾性分析.结果 9例患者均行手术治疗,经腹腔探查证实为美克尔憩室所致急性肠梗阻.术前仅1例患者确诊为美克尔憩室所致急性肠梗阻,8例仅诊断为肠梗阻;5例行憩室楔形切除术,4例行包括憩室在内的部分回肠切除术.术后病理学检查显示9例患者美克尔憩室均有炎性改变,部分病例憩室伴有黏膜糜烂、微小溃疡、出血或穿孔,4/9憩室中含有异位组织;全部患者术后均痊愈.结论 美克尔憩室是导致急性肠梗阻的少见病因,术前诊断困难,易发生肠绞窄,部分病例憩室中含有异位组织,应及时手术治疗.

Abstract：

Objective To analyze the clinical features of adult patients with acute intestinal obstruction secondary to Meckel's diverticulum and the experience in management of the disease.Methods The clinical data and pathological features of 9 patients with acute intestinal obstruction secondary to Meckel' s diverticulum were retrospectively analyzed. Results All patients were diagnosed with acute intestinal obstruction secondary to Meckel's diverticulum via abdominal cavity exploration and underwent surgical treatment. Before surgical treatment, 1 out of 9 patients was correctly diagnosed as acute intestinal obstruction secondary to Meckel's diverticulum, and the other 8patients were diagnosed as acute intestinal obstruction. Diverticulum was resected in 5 cases and the rest 4 cases received partial excision of small intestine including the diverticulum. Pathological examination showed that all patients had inflammatory changes in diverticulum. Some patients were complicated with mucosal erosion, small ulcers, bleeding or perforation. Forty-four percent (4/9) of diverticula contained ectopic tissue. All patients were cured. Conclusion Meckel's diverticulum is a rare cause of acute intestinal obstruction and preoperative diagnosis is difficult. Diverticulum,howere,is likelihood to develop strangulation or contains ectopic tissue, so that the surgical treatment should be performed early.     

Retained foreign bodies following intra-abdominal surgery.

BACKGROUND/AIMS: A retained foreign body in the abdominal cavity following surgery is a continuing problem. Despite precautions, the incidence is grossly underestimated. The purpose of this study is to report the result of surgical treatment on 24 consecutive cases treated by the authors during a 10-year period. METHODOLOGY: All consecutive patients with a confirmed diagnosis of foreign body after abdominal surgery were studied. Data collected included the patients' age and sex, the initial diagnosis and primary surgical treatment, period of time between the probable causative operation and the definitive treatment, nature of the foreign body, clinical presentation, predisposing factors, and diagnosis and management; morbidity and mortality are presented as well as guidelines for prevention. RESULTS: All patients were symptomatic. Eight patients presented as intraabdominal sepsis (4 with intestinal obstruction, 4 with entero- or colo-cutaneous fistula), non-specified abdominal pain in 3, persistent sinus and granuloma in 2, abdominal palpable mass in another 2 cases, and 1 patient with vaginal discharge. The diagnosis was established pre-operatively in 15 cases by means of plain abdominal radiographs, ultrasound or computed tomography (CT) scan. Morbidity was observed in 50% and the rate of surgical reinterventions because of fistulas or residual sepsis in 18%. The mortality was almost 10%. CONCLUSIONS: The clinical manifestations ranged from mild abdominal pain, palpable mass, persistent drainage and granuloma to intestinal obstruction secondary to adhesions or occlusion of the intestinal lumen because of migration of the foreign body and intraabdominal sepsis. Despite this being a rare situation, when it happens it presents as a very serious problem to patients with high rates of morbidity and mortality. Prevention remains the key to the problem.