Saqib Sabah Uddin, Farooq Rimsha, Saleem Omair, Moeen Sarosh, Chawla Tabish Umer
Aga Khan University Hospital, Karachi, Pakistan.
Surg Case Rep. 2021 Apr 13;7(1):93. doi: 10.1186/s40792-021-01179-7.
Abdominal cocoon syndrome is a rare cause of intestinal obstruction in which loops of small bowel get entrapped inside a fibro-collagenous membrane. Condition is also known in the literature as sclerosing peritonitis and in the majority of cases, it has no known cause. Although the majority of patients exhibit long-standing signs and symptoms of partial bowel obstruction in an out-patient clinic, its acute presentation in the emergency room with features of sepsis is extremely rare. This case report aims to describe the emergency presentation of cocoon abdomen with septic peritonitis.
A 35-year-old male with no known co-morbidity and no prior history of prior laparotomy presented in emergency room first time with a 1-day history of generalized abdomen pain, vomiting, and absolute constipation. He was in grade III shock and had metabolic acidosis. The clinical impression was of the perforated appendix, but initial contrast-enhanced computed tomography (CECT) was suggestive of strangulated internal herniation of small bowel. Emergency laparotomy after resuscitation revealed hypoperfused, but viable loops of small bowel entrapped in the sclerosing membrane. Extensive adhesiolysis and removal of the membrane were performed and the entire bowel was straightened. Postoperatively he remained well and discharged as planned. Histopathology report confirms features of sclerosing peritonitis.
Cocoon abdomen is a very rare cause of acute small bowel obstruction presenting in an emergency with features of septic peritonitis. Condition is mostly chronic and generally mimics abdominal TB in endemic areas like India and Pakistan. A high index of suspicion is required in an emergency setting and exploratory laparotomy is diagnostic and therapeutic as well and the condition mimics internal herniation in acute cases.
Cocoon abdomen as a cause of septic peritonitis is extremely rare and might be an unexpected finding at laparotomy. Removal of membrane and estimation of the viability of entrapped bowel loops is the treatment of choice, which may require resection in the extreme case of gangrene.
腹茧症是肠梗阻的一种罕见病因，其中小肠袢被包裹在纤维胶原膜内。该病症在文献中也被称为硬化性腹膜炎，在大多数情况下，病因不明。尽管大多数患者在门诊表现为长期的部分肠梗阻体征和症状，但其在急诊室以脓毒症特征急性发作极为罕见。本病例报告旨在描述腹茧症合并感染性腹膜炎的急诊表现。
一名35岁男性，无已知合并症，既往无剖腹手术史，首次因1天的全腹疼痛、呕吐和完全便秘就诊于急诊室。他处于III级休克状态，并有代谢性酸中毒。临床印象为阑尾穿孔，但最初的增强计算机断层扫描（CECT）提示小肠绞窄性内疝。复苏后急诊剖腹探查发现小肠袢灌注不良但存活，被包裹在硬化膜内。进行了广泛的粘连松解和膜切除，整个肠道被理顺。术后他恢复良好，并按计划出院。组织病理学报告证实了硬化性腹膜炎的特征。
腹茧症是急性小肠梗阻的一种非常罕见的病因，在急诊中表现为感染性腹膜炎的特征。该病症大多为慢性，在印度和巴基斯坦等流行地区通常类似腹部结核。在急诊情况下需要高度怀疑，剖腹探查既是诊断方法也是治疗方法，在急性病例中该病症类似内疝。
腹茧症作为感染性腹膜炎的病因极为罕见，可能是剖腹手术时的意外发现。切除膜并评估被困肠袢的活力是首选治疗方法，在坏疽的极端情况下可能需要切除。
