Objective To analyze retrospectively the clinical manifestation and radiological findings of abdominal cocoon combined with the diagnosis, treatment and prognosis. Methods The data of 9 patients with abdominal cocoon in our hospital from January 2007 to June 2018 were reviewed including clinical feature and follow-up. Results Four cases were diagnosed as abdominal cocoon by CT examination before operation, and the remaining five cases were diagnosed by laparotomy. One case received non-operative treatment and 8 cases had operation. During the operation, some cases were found part of small intestine to be encapsulated in a cocoon-like membrane, some had all small intestine wrapped and some had part of colon involved. The main operation was to excise cocoon, lysis adhesion and release intestine. One case died due to multiple organ failure and 4 cases had early intestinal obstruction postoperatively. During a follow-up of 8 cases within the period from 6 months to 10 years, 1 case was lost followed up. Chronic abdominal pain was found in 1 case, intestinal obstruction in 2 cases and abdominal distention in 1 case. The other 3 cases recovered well. Conclusions Preoperative diagnosis of abdominal cocoon is difficult for there is no specific clinical manifestations. The characteristic images of abdominal enhanced CT scan with or without two dimensional reformations may be preoperative diagnostic clues. The main treatment of abdominal cocoon is surgery, and the overall prognosis of patients is satisfactory.
XIA Yi, TANG Yonghua, GENG Zhichao, ZHAO Xuesong, HUANG Liang, MAO Enqiang, CHEN Erzhen, WANG Xiaoyan
. Clinical analysis of abdominal cocoon: a report of 9 cases[J]. Journal of Surgery Concepts & Practice, 2019
, 24(03)
: 259
-263
.
DOI: 10.16139/j.1007-9610.2019.03.017
[1] Foo KT, Ng KC, Rauff A, et al.Unusual small intestinal obstruction in adolescent girls: the abdominal cocoon[J]. Br J Surg,1978,65(6):427-430.
[2] Jagdale A,Prasla S,Mittal S.Abdominal cocoon- A rare etiology of intestinal obstruction[J]. J Family Med Prim Care,2017,6(3):674-676.
[3] Xia J, Xie W, Chen L, et al.Abdominal cocoon with early postoperative small bowel obstruction: A case report and review of literature in China[J]. Medicine (Baltimore),2018,97(25):e11102.
[4] Al-Azzawi M, Al-Alawi R. Idiopathic abdominal cocoon: a rare presentation of small bowel obstruction in a virgin abdomen. How much do we know?[J]. BMJ Case Rep,2017,2017. pii: bcr-2017-219918.
[5] Lim MC, Chotai NC, Giron DM.Idiopathic sclerosing encapsulating peritonitis: A rare cause of subacute intestinal obstruction[J]. Case Rep Med,2016,2016:8206894.
[6] Uzunoglu Y, Altintoprak F, Yalkin O, et al.Rare etiology of mechanical intestinal obstruction: Abdominal cocoon syndrome[J]. World J Clin Cases,2014,2(11):728-731.
[7] Sahoo SP, Gangopadhyay AN, Gupta DK, et al.Abdominal cocoon in children a report of four cases[J]. J Pediatr Surg,1996,31(7):987-988.
[8] Li S, Wang JJ, Hu WX, et al.Diagnosis and treatment of 26 cases of abdominal cocoon[J]. World J Surg,2017,41(5):1287-1294.
[9] Wei B, Wei HB, Guo WP, et al.Diagnosis and treatment of abdominal cocoon: a report of 24 cases[J]. Am J Surg,2009,198(3):348-353.
[10] Hur J, Kim KW, Park MS, et al.Abdominal cocoon: preoperative diagnostic clues from radiologic imaging with pathologic correlation[J]. Am J Roentgenol,2004, 182(3):639-641.
[11] Gupta S, Shirahatti RG, Anand J.CT findings of an abdominal cocoon[J]. Am J Roentgenol,2004,183(6):1658-1660.
[12] Wang Q, Wang D.Abdominal cocoon: multi-detector row CT with multiplanar reformation and review of literatures[J]. Abdom Imaging,2010,35(1):92-94.
[13] Jovani M, Baticci F, Bonifacio C, et al.Abdominal cocoon or idiopathic encapsulating peritoneal sclerosis: magnetic resonance imaging[J]. Dig Liver Dis,2014,46(2):192-193.
[14] Akbulut S. Accurate definition and management of idiopathic sclerosing encapsulating peritonitis[J]. World J Gastroenterol,2015,14,21(2):675-687.
[15] Habib SM, Betjes MG, Fieren MW, et al.Management of encapsulating peritoneal sclerosis: a guideline on optimal and uniform treatment[J]. Neth J Med,2011,69(11):500-507.
[16] 李毅, 李宁, 朱维铭, 等. 原发性腹茧症外科治疗67例临床分析[J]. 中华外科杂志,2013,51(2):139-141.
[17] Ertem M, Ozben V, Gok H, et al.An unusual case in surgical emergency: Abdominal cocoon and its laparoscopic management[J]. J Minim Access Surg,2011,7(3):184-186.