Mohakud Sudipta, Juneja Aparna, Lal Hira
Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Odisha, India.
Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
BMJ Case Rep. 2019 May 31;12(5):e229983. doi: 10.1136/bcr-2019-229983.
A 23-year-old man presented to the emergency department with a history of recurrent episodes of subacute intestinal obstruction. Palpation revealed a firm, non-tender, mobile, non-pulsatile mass of size 8-10 cm with indistinct margins and smooth surface in the hypogastrium. Contrast-enhanced CT scan of the abdomen showed clumping of the small bowel loops within a well-defined membrane-like structure without dilatation or thickening of bowel loops. The patient underwent a laparotomy with incision of the membrane and separation of all the small bowel loops inside the cocoon. Abdominal cocoon is the idiopathic variety of sclerosing encapsulating peritonitis and is an unusual cause of acute or subacute intestinal obstruction. Clinical diagnosis is difficult because of non-specific symptoms. CT has facilitated accurate preoperative diagnosis, long before the patient presents with full-fledged symptoms of acute intestinal obstruction. CT scan plays a significant role in excluding the secondary causes and helps in patient management.
一名23岁男性因反复出现亚急性肠梗阻发作史就诊于急诊科。触诊发现下腹部有一个质地坚硬、无压痛、可活动、无搏动的肿块，大小为8 - 10厘米，边界不清，表面光滑。腹部增强CT扫描显示小肠肠袢聚集在一个边界清晰的膜状结构内，肠袢无扩张或增厚。患者接受了剖腹手术，切开膜并分离茧内所有小肠肠袢。腹茧症是硬化性包裹性腹膜炎的特发性类型，是急性或亚急性肠梗阻的罕见原因。由于症状不具特异性，临床诊断困难。在患者出现急性肠梗阻的典型症状之前很久，CT就有助于准确的术前诊断。CT扫描在排除继发性病因方面发挥着重要作用，并有助于患者的管理。
