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.     

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。     

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。     

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.     

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。     

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。     

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.     

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.     

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.     

Accurate definition and management of idiopathic sclerosing encapsulating peritonitis

AIM: To review the literature on idiopathic sclerosing encapsulating peritonitis(SEP), also known as abdominal cocoon syndrome. METHODS: The Pub Med, MEDLINE, Google Scholar, and Google databases were searched using specific key words to identify articles related to idiopathic SEP. These key words were "sclerosing encapsulating peritonitis," "idiopathic sclerosing encapsulating peritonitis," "abdominal cocoon," and "abdominal cocoon syndrome." The search included letters tothe editor, case reports, review articles, original articles, and meeting presentations published in the English-language literature from January 2000 to May 2014. Articles or abstracts containing adequate information about age, sex, symptom duration, initial diagnosis, radiological tools, and surgical approaches were included in the study. Papers with missing or inadequate data were excluded. RESULTS: The literature search yielded 73 articles on idiopathic(primary) SEP published in 23 countries. The four countries that published the greatest number of articles were India(n = 21), Turkey(n = 14), China(n = 8) and Nigeria(n = 3). The four countries that reported the greatest number of cases were China(n = 104; 53.88%), India(n = 35; 18.13%), Turkey(n = 17; 8.80%) and Nigeria(n = 5; 2.59%). The present study included 193 patients. Data on age could be obtained for 184 patients(range: 7-87 years; mean ± SD, 34.7 ± 19.2 years), but were unavailable for nine patients. Of the 184 patients, 122 were male and 62 were female; sex data could not be accessed in the remaining nine patients. Of the 149 patients whose preoperative diagnosis information could be obtained, 65(43.6%) underwent operations for abdominal cocoon, while the majority of the remaining patients underwent operations for a presumed diagnosis of intestinal obstruction and/or abdominal mass. Management information could be retrieved for 115 patients. Of these, 68 underwent excision + adhesiolysis(one laparoscopic); 24 underwent prophylactic appendectomy in addition to excision + adhesiolysis. Twenty patients underwent various resection and repair techniques along with excision + adhesiolysis. The remaining three patients were managed with antituberculosis therapy(n = 2) and immunosuppressive therapy(n = 1). CONCLUSION: Idiopathic SEP is a rare disorder characterized by frequently recurring bouts of intestinal obstruction. Surgical therapy is the gold standardmanagement strategy.     

谷氨酰胺在腹部术后肠梗阻患者保守治疗中的意义

目的:探讨谷氨酰胺(Glutamine,Gln)在腹部术后肠梗阻患者保守治疗中保护肠黏膜屏障的作用.方法:将收治的58例有腹部手术史且临床诊断为肠梗阻的患者随机分为对照组与治疗组.对照组给予常规治疗:禁食、持续胃肠减压、维持水电解质和酸碱平衡、应用抗生素、生长抑素和全胃肠外营养(TPN)等;治疗组在上述常规治疗的基础上,给予Gln强化的TPN.治疗前对所有患者进行胃肠功能障碍评分,比较两组患者治疗前、治疗4d、治疗8d、治疗12d后血清D-乳酸浓度、肠脂肪酸结合蛋白(I FA B P)水平,记录患者肠道功能恢复时间(d),采用P e a r s o n相关、重复测量资料的方差分析及两独立样本均数比较t检验进行统计学分析.结果:肠梗阻患者外周血中D-乳酸浓度、IFABP水平与肠功能障碍评分值呈正相关(r=0.824,r=0.891,均P<0.001);随治疗时间延长,治疗组与对照组患者血清D-乳酸、IFABP水平均呈下降趋势,治疗组下降趋势更明显;治疗组肠道功能恢复时间短于对照组(6.83d±1.49d vs8.76d±1.53d),差异有统计学意义(P<0.001).结论:在腹部术后肠梗阻患者的常规治疗基础上...     

Intraperitoneal administration of adenosine inhibits formation of abdominal adhesions

PURPOSE: Previously we demonstrated that peritoneal lavage with high concentrations of adenosine (1 mM) provides pharmacologic levels of adenosine in the intestines without elevating adenosine levels in the systemic circulation and without causing systemic hemodynamic effects (Alimentary Pharmacology & Therapeutics 2000;14:1371–80). Because adenosine can be safely administered into the peritoneal cavity, and because it inhibits fibroblast proliferation and collagen production and inflammation and enhances angiogenesis, we tested the hypothesis that adenosine applied into the abdominal cavity safely and effectively reduces formation of abdominal adhesions.METHODS: To test this hypothesis, in Sprague-Dawley rats, a window of right parietal peritoneum was removed and the cecum was brushed and placed next to the damaged peritoneum. After injury, rats received in the abdominal cavity either 20 ml of saline (n = 12, Saline Group) or 20 ml of 1 mM adenosine (n = 12, Adenosine 1X Group; and n = 12, Adenosine 4X Group). At 24, 48, and 72 hours after surgery, rats received by intraperitoneal injection either 10 ml of saline (Saline Group and Adenosine 1X Group) or 10 ml of 1 mM adenosine (Adenosine 4X Group).RESULTS: After 14 days, the degree of adhesion formation was scored (0 to 4) by a blinded observer. Animals tolerated the adenosine treatments without signs of discomfort or distress. The adhesion scores were 2.6 ± 0.34, 1.7 ± 0.40, and 0.74 ± 0.29 in the Saline, Adenosine 1X, and Adenosine 4X groups, respectively (P = 0.0035, Kruskal-Wallis analysis of variance).CONCLUSION: Peritoneal administration of 1 mM adenosine safely and effectively reduces adhesion formation.This work was supported by The Center for Clinical Pharmacology, University of Pittsburgh, Pittsburgh, Pennsylvania.     

2011年至2021年我国416例腹内疝性肠梗阻患者临床特征及相关因素的分析

目的分析腹内疝性肠梗阻临床特征及相关因素,加强对不同类型腹内疝性肠梗阻发病特点及相关因素的认识,提高临床治疗效果。方法以“腹内疝性肠梗阻”为检索词,在中国知网、万方、维普等数据库检索发表于2011年2月至2021年2月的文献,纳入文献18篇,共计416例腹内疝性肠梗阻患者,分别总结腹内疝性肠梗阻患者的年龄、性别、临床特征、疾病类型、治疗方式及预后。结果416例腹内疝性肠梗阻患者男232例,女184例,男女比例为1.26∶1,患者年龄9~83岁,中位年龄50.83岁,以中年人为主,患者既往有手术史的381例(91.59%),手术史是患者发病的主要病因,临床表现为腹痛、腹胀373例(89.66%),恶心、呕吐360例(86.54%),肛门排气减少或停止373例(89.66%),肠鸣音亢进或存在气过水声372例(89.42%),肠鸣音减弱44例(10.58%),腹部CT是明确诊断的首选检查方法,影像学特征主要是液气平面306例(73.56%),存在血性腹水16例(3.85%)。明确诊断的有效病例306例(73.56%),手术治疗370例(88.94%),保守治疗46例(11.06%)。治愈402例(96.63%),死亡14例(3.37%),治疗不及时(内脏组织坏死、穿孔)及治疗方式不当(术后未有效抗感染或未能维持内环境的平衡)导致感染性休克、弥漫性血管内凝血是死亡主要原因。结论腹内疝性肠梗阻患者好发于男性,与既往手术史密切相关,影像学特别是CT检查可协助诊断,临床医师需提高对腹内疝性肠梗阻的诊治水平,精确掌控病情以提高临床治疗效果。     

A prospective study assessing the efficacy of abdominal computed tomography scan without bowel preparation in diagnosing intestinal wall and luminal lesions in patients presenting to the emergency room with abdominal complaints

AIM: To evaluate the positive predictive value of abdominal non-prepared computed tomography (CT) for diagnosing intestinal lumen or wall lesions in patients presenting to the emergency room (ER) with abdominal complaints. METHODS: For 1-year we prospectively evaluated all ER patients hospitalized after abdominal CT scan detected either intraluminal or intestinal wall lesions. These patients underwent colonoscopy serving as gold standard. Patients with prior abdominal pathology or CT findings of appendicitis or diverticulitis were excluded. RESULTS: Five hundred and sixty-eight abdominopelvic CT scans were performed in the ER, 96 had positive colonic findings. Sixty-two patients were excluded, 46 because of diverticulitis or appendicitis, 16 because of prior abdominal pathology. Of the remaining 34 patients, 14 did not undergo colonoscopy during hospitalization. Twenty eligible patients were included in the study. The positive predictive value of the CT scans performed in the ER was calculated to be 45% (95% CI 25-67). CONCLUSION: CT findings correlated with colonoscopic findings only in approximately half of the cases. Relying on non-prepared CT scan findings in planning patient management and colonoscopy may lead to unnecessary diagnostic work-ups.