Division of Surgical Gastroenterology, Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal.
Clin J Gastroenterol. 2021 Apr;14(2):577-580. doi: 10.1007/s12328-021-01344-3. Epub 2021 Jan 21.
Abdominal cocoon syndrome coexistent with military tuberculosis is a very rare entity, and its occurrence in a young adult male has not been previously reported. The disease in combination with military tuberculosis is associated with significant morbidity and mortality if underdiagnosed and untreated; hence, a high index of suspicion is required in a patient with tuberculosis presenting with intestinal pseudo-obstruction. The ideal treatment of the combination is surgical excision of cocoon along with oral anti-tubercular therapy (ATT), when the initial conservative management fails. However, surgery is frequently complicated by iatrogenic enterotomy due to the fibrinous cocoon. The best option in these cases may be a bail-out method of diverting jejunostomy. This helps relieve intestinal pseudo-obstruction and promotes early initiation of ATT as has been demonstrated in the present case.
腹腔茧症合并军人结核是一种非常罕见的疾病，其在年轻男性中的发生尚未见报道。如果诊断和治疗不及时，该病与军人结核合并存在会导致较高的发病率和死亡率；因此，对于患有结核并出现肠假性梗阻的患者，需要高度怀疑该病的存在。对于这种组合，当初始保守治疗失败时，理想的治疗方法是手术切除茧并进行口服抗结核治疗（ATT）。然而，由于纤维性茧，手术常常会因医源性肠切开而复杂化。在这种情况下，最好的选择可能是采用紧急转流性空肠造口术。正如本病例所示，这种方法有助于缓解肠假性梗阻，并促进 ATT 的早期启动。
