Al Ani Amer Hashim, Al Zayani Najah, Najmeddine Mohammad, Jacob Sunitha, Nair Sunil
Department of General Surgery, Bahrain Specialist Hospital, Manama, Bahrain.
Department of Gastroenterology and Hepatology, Bahrain Specialist Hospital, Manama, Bahrain.
Int J Surg Case Rep. 2014;5(10):735-8. doi: 10.1016/j.ijscr.2014.07.017. Epub 2014 Aug 19.
Abdominal cocoon (sclerosing encapsulating peritonitis) (SEP) is a rare condition, mostly affecting adolescent girls living in tropical/subtropical region. Its etiology is unknown. It may cause acute or sub-acute intestinal obstruction.
We report here a 39 year old male who complained of long standing colicky abdominal pain, with significant weight loss. Abdomen CT scan showed clumping of ileal loops at the level of umbilicus, with a thin capsule surrounding it. Laparoscopy revealed abdominal cocoon, biopsy of which showed dense hypocellular fibro-collagenous tissue with no neoplastic or granulomatous process. Excision of fibrous tissue and release of adhesions was done. Patient was symptoms free after five months follow up.
Abdominal exploration is usually needed for the diagnosis and treatment of abdominal cocoon. A thick fibrotic peritoneal wrapping of the bowel is usually found. Complete recovery is the result in majority of cases after surgical removal of the wrap causing the cocoon.
Primary sclerosing encapsulating peritonitis (cocoon abdomen) diagnosis needs a high index of suspicion, as signs and symptoms are nonspecific and imaging findings are not always conclusive. Careful excision of the accessory peritoneal sac and lysis of adhesions between bowels is the best treatment. Prognosis is generally good.
腹茧症（硬化性包裹性腹膜炎）（SEP）是一种罕见疾病，主要影响生活在热带/亚热带地区的青春期女孩。其病因不明。它可能导致急性或亚急性肠梗阻。
我们在此报告一名39岁男性，主诉长期存在绞痛性腹痛，伴有显著体重减轻。腹部CT扫描显示脐水平回肠袢聚集，周围有一层薄包膜。腹腔镜检查发现腹茧症，活检显示为致密的低细胞性纤维胶原组织，无肿瘤或肉芽肿性病变。进行了纤维组织切除和粘连松解。随访五个月后患者症状消失。
腹茧症的诊断和治疗通常需要进行腹部探查。通常会发现肠管被一层厚厚的纤维化腹膜包裹。大多数情况下，手术切除导致腹茧症的包裹后可完全康复。
原发性硬化性包裹性腹膜炎（茧状腹）的诊断需要高度怀疑，因为其体征和症状不具特异性，影像学表现也并非总是决定性的。仔细切除附属腹膜囊并松解肠管间粘连是最佳治疗方法。总体预后良好。
