Menberu Endeshaw, Guteta Solomon, Bekele Tesfaye, Mengistu Simeon Mulugeta, Aliye Yonathan, Daba Merga, Mustefa Abdulhamid
Department of Surgery, College of Medicine and Health Sciences Ambo University Ambo Ethiopia.
Department of Surgery, College of Health Sciences Addis Ababa University Addis Ababa Ethiopia.
Clin Case Rep. 2024 Aug 5;12(8):e9264. doi: 10.1002/ccr3.9264. eCollection 2024 Aug.
Abdominal cocoon syndrome is a rare cause of bowel obstruction, with variable presentation. It needs a high index of suspicion for diagnosis. Surgical management with the release of adhesions is the preferred option for a healthy bowel. Iatrogenic bowel perforation is a possibility during bowel manipulation and the release of thick fibrous adhesions resulting in bowel resection.
Abdominal cocoon syndrome, also known as encapsulating peritoneal sclerosis, is a rare cause of intestinal obstruction in which the small intestine may be entirely or partially wrapped in a thick sac of fibrous tissue that resembles a cocoon. We present a male Ethiopian patient, 60 years of age, who had a 6-day history of symptoms of intermittent intestinal obstruction. Before his current presentation, he had a 6-month history of sporadic vomiting and periodic abdominal pain. These symptoms would go away on their own. An exploratory laparotomy was performed for the preoperative diagnosis of small intestine obstruction secondary to primary small bowel volvulus after a plain abdomen x-ray confirmed the small bowel obstruction diagnosis. But during surgery, we discovered something unexpected: a mass formed by the encasing membrane over the small bowel. En bloc resection of the mass and distal ileum with ileo-transverse anastomosis was performed. The patient was discharged after 5 days of an uneventful post-operative stay. The morbidity and mortality of this rare instance can be decreased by awareness, prompt diagnosis, and appropriate intervention. We discuss diagnostic and therapeutic challenges encountered during the management of this patient.
腹茧症是肠梗阻的罕见病因，临床表现多样。诊断需要高度怀疑。对于肠道健康的情况，手术松解粘连是首选方案。在肠道操作及松解致密纤维粘连过程中有可能发生医源性肠穿孔，进而导致肠切除。
腹茧症，又称包裹性腹膜硬化症，是肠梗阻的罕见病因，其中小肠可能全部或部分被一层类似茧的厚纤维组织囊包裹。我们报告一名60岁的埃塞俄比亚男性患者，有6天间歇性肠梗阻症状病史。在此次就诊前，他有6个月的散发性呕吐和周期性腹痛病史，这些症状会自行缓解。在腹部平片证实小肠梗阻诊断后，因术前诊断为原发性小肠扭转继发小肠梗阻而进行了剖腹探查术。但在手术过程中，我们发现了意想不到的情况：小肠上有一层包裹膜形成的肿块。对肿块及远端回肠进行了整块切除并做了回肠 - 横结肠吻合术。术后恢复顺利，5天后患者出院。通过提高认识、及时诊断和适当干预，可降低这种罕见病例的发病率和死亡率。我们讨论了该患者治疗过程中遇到的诊断和治疗挑战。
