腹茧症1例并文献复习

doi:10.3969/j.issn.1004-583X.2023.09.010

临床荟萃 ›› 2023, Vol. 38 ›› Issue (9): 827-831.doi: 10.3969/j.issn.1004-583X.2023.09.010

腹茧症1例并文献复习

王晓婷^a, 王妍^a(), 冯志杰^a, 姚冬梅^a, 杨鑫铖^a, 邱少凡^b, 李孟^c, 田晖^d

a.河北医科大学第二医院消化内科,河北石家庄 050000
b.河北医科大学第二医院胃肠外科,河北石家庄 050000
c.河北医科大学第二医院医学影像科,河北石家庄 050000
d.河北医科大学第二医院腹部超声科,河北石家庄 050000

收稿日期:2023-06-15 出版日期:2023-09-20 发布日期:2023-11-21
通讯作者: 王妍, Email: wangyan_2006@aliyun.com

A case report of abdominal cocoon syndrome and literature review

Wang Xiaoting^a, Wang Yan^a(), Feng Zhijie^a, Yao Dongmei^a, Yang Xincheng^a, Qiu Shaofan^b, Li Meng^c, Tian Hui^d

a. Department of Gastroenterology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China
b. Department of Gastrointestinal Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China
c. Department of Medical Imaging,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China
d. Department of Abdominal Ultrasound,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China

Received:2023-06-15 Online:2023-09-20 Published:2023-11-21
Contact: Wang Yan,Email: wangyan_2006@aliyun.com

摘要/Abstract

摘要：

目的通过分析1例腹茧症(abdominal cocoon syndrome,AC)病例,探讨这一罕见病的诊断与治疗。方法回顾性分析腹茧症患者1例,并复习相关文献。结果患者男性,72岁,以恶心、呕吐、腹痛入院,消化道造影考虑高位不全肠梗阻,腹部CT可疑AC,行剖腹探查术见胃、小肠、结肠及肠系膜均被纤维膜包裹,遂行肠黏连松解术,术后患者症状好转出院。结论 AC缺乏特征性临床表现,患者通常以恶心、呕吐、停止排气排便等肠梗阻表现就诊,需通过病史及影像学检查、甚至剖腹探查来诊断。手术是最为彻底的治疗方法,可有效缓解患者症状。

关键词: 腹茧症, 纤维包裹, 肠梗阻

Abstract:

Objective To investigate the diagnosis and treatment of the rare abdominal cocoon syndrome (AC) by a case report. Methods Clinical data of a case of AC were analyzed retrospectively, and the relevant literatures were reviewed. Results A 72-year-old male patient presented with nausea, vomiting and abdominal pain. Double-contrast radiography of the upper gastrointestinal tract suggested the incomplete intestinal obstruction of the upper segment of the intestine. The abdominal CT suggested the suspected AC. Consequently, the exploratory laparotomy was performed, and we found that the stomach, small intestine, colon and mesentery were all surrounded by fibrous capsules. Ultimately, intestinal adhesiolysis was carried out, and the patient’s condition improved and discharged. Conclusion Clinical manifestations of AC are atypical. Affected patients usually ask for medical help due to clinical symptoms of intestinal obstruction like nausea, vomiting and failure of defecation and gas pass. Its diagnosis depends on the history medical, imaging examinations and even exploratory laparotomy. Surgery is the most effective therapeutic strategy for AC, which effectively alleviates the clinical symptoms and signs.

Key words: abdominal cocoon, fibrous capsule formation, intestinal obstruction

中图分类号:

R572.2

王晓婷, 王妍, 冯志杰, 姚冬梅, 杨鑫铖, 邱少凡, 李孟, 田晖. 腹茧症1例并文献复习[J]. 临床荟萃, 2023, 38(9): 827-831.

Wang Xiaoting, Wang Yan, Feng Zhijie, Yao Dongmei, Yang Xincheng, Qiu Shaofan, Li Meng, Tian Hui. A case report of abdominal cocoon syndrome and literature review[J]. Clinical Focus, 2023, 38(9): 827-831.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.09.010

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I9/827

图/表 8

图1 消化道造影示十二指肠扩张, 提示高位不全梗阻

Fig. 1 Double-contrast radiography of the upper gastrointestinal tract shows duodenal dilation, suggesting the incomplete intestinal obstruction of the upper segment of the intestine

图2 胃镜检查胃底示黏膜充血水肿、大量黄绿色胃内容物潴留

Fig. 2 Gastroscopy shows congestion and edema of the mucosa of the gastric fundus, and a large amount of yellow-green gastric contents

图3 腹部CT结果示肠外被一层纤维膜包裹(箭头所示)

Fig. 3 The abdominal CT shows that the outside intestine is surrounded by fibrous capsules (indicated by arrows)

图4 小肠镜示十二指肠水平部及空肠起始部肠腔似增宽, 继续进镜注气, 肠腔扩张受限

Fig. 4 Enteroscopy shows the widening of the horizontal part of duodenum and the initial portion of the jejunum. With the continuous gas insufflation, intestinal dilation is restricted

图5 肠管彩色超声示中上腹局部小肠淤张伴周围系膜增厚

Fig. 5 Intestinal ultrasound shows local small bowel stasis in the mid-upper abdomen with peripheral mesangial thickening

图6 患者肠黏连松解术中可见白色膜状结构包绕肠管, 形似“蚕茧”(箭头所示)

Fig. 6 During intestinal adhesiolysis, white membranous structures can be seen wrapped around the intestinal tube, resembling a “silkworm cocoon” (indicated by arrows)

图7 患者术中剥离的纤维组织

Fig. 7 Fibrous tissue stripped during surgery

图8 病理示纤维壁样组织

Fig. 8 Pathology shows fibrocystic tissues

参考文献 20

[1]	Kirshtein B, Mizrahi S, Sinelnikov I, et al. Abdominal cocoon as a rare cause of small bowel obstruction in an elderly man: Report of a case and review of the literature[J]. Indian J Surg, 2011, 73(1): 73-75. doi: 10.1007/s12262-010-0200-7 pmid: 22211046
[2]	Jie X, WeiJia X, Li C, 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.
[3]	Ye Y, Cao L, Zhang Z, et al. Abdominal cocoon syndrome: An extremely rare cause of intestinal obstruction[J]. Asian J Surg, 2022, 45(10): 1868-1869. doi: 10.1016/j.asjsur.2022.03.115 URL
[4]	Stefano T, Guendalina G, Michele B, et al. A forensic case of abdominal cocoon syndrome[J]. Forensic Sci Med Pathol, 2022, 19(2): 273-279. doi: 10.1007/s12024-022-00562-6 pmid: 36459388
[5]	Karl AP, Leebmann H, Zorger N. Abdominal Cocoon Syndrome[J]. Dtsch Arztebl Int, 2019, 116(27-28): 486.
[6]	Sharma V, Mandavdhare HS, Rana SS, et al. Role of conservative management in tubercular abdominal cocoon: A case series[J]. Infection, 2017, 45(5): 601-606. doi: 10.1007/s15010-017-1012-5 pmid: 28341896
[7]	Browne LP, Patel J, Guillerman RP, et al. Abdominal cocoon: a unique presentation in an immunodeficient infant[J]. Pediatr Radiol, 2012, 42(2): 263-266. doi: 10.1007/s00247-011-2135-y pmid: 21713442
[8]	张雪, 王亚丽, 崔彦收. 腹茧症累及小肠及结肠1例并文献复习[J]. Chinese Journal of Difficult and Complicated Cases 疑难病杂志, 2020, 19(12): 1272-1273.
[9]	Yu R, Ya Y, Ni X, et al. Imaging and treatment of idiopathic abdominal cocoon in 9 patients[J]. Exp Ther Med, 2020, 19(1): 651-657. doi: 10.3892/etm.2019.8258 pmid: 31885704
[10]	顾卯林, 杨捷, 黄永刚, 等. 腹茧症5例的临床诊治效果[J]. 中国中西医结合外科杂志, 2022, 28(6): 905-908.
[11]	李斌斌, 杨小华, 温阳辉, 等. 腹茧症的临床特点与诊治经验[J]. 中华普通外科杂志, 2020, 35(6): 468-470.
[12]	赵宝成, 王振军, 魏广辉, 等. 腹茧症五例的临床分析[J]. 中华普通外科杂志, 2018, 33(2): 109-110.
[13]	Hur J, Kim KW, Park MS, et al. Abdominal cocoon: preoperative diagnostic clues from radiologic imaging with pathologic correlation[J]. AJR Am J Roentgenol, 2004, 182(3): 639-641. doi: 10.2214/ajr.182.3.1820639 URL
[14]	马洪兵, 周丹. 腹茧症的CT诊断及临床表现分析[J]. 医学影像学杂志, 2019, 29(5): 865-868.
[15]	阮志兵, 焦俊, 闵定玉, 等. 腹茧症的临床特点与CT诊断价值(附16例报道)[J]. 临床放射学杂志, 2017, 36(12): 1825-1830.
[16]	李胜, 刘鲜艳, 文波, 等. 26例腹茧症的诊治体会[J]. 中华普通外科杂志, 2020, 35(4): 300-303.
[17]	Pratit P, Yogendra B, Rabindra D, et al. Abdominal cocoon syndrome[J]. J Nepal Health Res Counc, 2019, 17(2):264-266. doi: 10.33314/jnhrc.v0i0.1934 pmid: 31455947
[18]	Alsadery HA, Busbait S, AlBlowi A, et al. Abdominal cocoon syndrome (idiopathic sclerosing encapsulating peritonitis): An extremely rare cause of small bowel obstruction-Two case reports and a review of literature[J]. Front Med (Lausanne), 2022, 9: 1003775.
[19]	Akbulut S. Accurate definition and management of idiopathic sclerosing encapsulating peritonitis[J]. World J Gastroenterol, 2015, 21(2): 675-687. doi: 10.3748/wjg.v21.i2.675 URL
[20]	Çolak Ş, Bektaş H. Abdominal cocoon syndrome: A rare cause of acute abdomen syndrome[J]. Ulus Travma Acil Cerrahi Derg, 2019, 25(6): 575-579. doi: 10.14744/tjtes.2019.48380 pmid: 31701503

腹茧症1例并文献复习

A case report of abdominal cocoon syndrome and literature review

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