abdominal cocoon
Introduction
Introduction to abdominal cramps Abdominal cocoon is characterized by a small intestine wrapped in a layer of abnormal fibrous membrane, so it is also known as congenital intestinal obstruction, small intestinal hernia, intracapsular adhesive intestinal obstruction and small intestine segment. Sexual fiber encapsulation group, abdominal cavity wraps and so on. The disease is a rare, unexplained special type of intestinal obstruction, first reported and named by Foo in 1978. There is a lack of clinical understanding, and it is often difficult to diagnose. basic knowledge The proportion of illness: 0.001% Susceptible people: more than women Mode of infection: non-infectious Complications: intestinal obstruction
Cause
Causes of abdominal cramps
(1) Causes of the disease
The cause of abdominal cramps is unknown and may be related to the following factors.
1. Secondary to some kind of intra-abdominal inflammation Foo et al believe that this disease occurs mostly in women, the onset time is often within 2 years of menarche, it is speculated that menstrual blood may enter the abdominal cavity through the fallopian tube, causing subclinical primary peritonitis fiber exudation Due to the mechanization, Sieck et al., based on the regional characteristics of the disease and the characteristics of adolescent women, suggest that the sequelae of peritonitis may be caused by retrograde infection of pathogens that are easily invaded by the genital tract, but these speculations have not been confirmed, and the male patient cannot be explained. The onset of the disease, found that intra-intestinal adhesions in the capsule are also different from the peritoneal adhesions caused by general infection.
2. Congenital dysplasia Most scholars believe that abdominal cramps are congenital dysplasia plus acquired factors, the reason is that the capsule is very intact, smooth, no adhesion to the parietal peritoneum, some pathological examination confirmed the peritoneum Structure, high rate of abdominal malformation (54.3%), often lack of omentum, it is speculated that the abnormal omental dysplasia or small mesenteric double socket development, resulting in the capsule intestine The cause of adhesion may be related to acquired factors. Some scholars believe that abdominal cramps are a congenital duodenal fistula or mesenteric hernia.
3. Drug effects Seng reported cases of propranolol (propranolol) (80mg / d), considered that propranolol beta-blockers reduce the control of normal proliferation of the ring gland The ratio of cAMP (cAMP) to cyclic guanosine monophosphate (cGMP) leads to excessive collagen hyperplasia and peritoneal fibrosis.
4. Primary peritonitis Francis noticed that the incidence of abdominal cramps in patients with cirrhosis, nephritis, malignant tumors and heart failure with ascites is high, especially in patients with cirrhosis after LeVeen shunt surgery, Wang Ronghua reported tuberculosis The incidence of peritonitis patients is high.
(two) pathogenesis
The small intestine is wrapped in a silkworm-like shape by an abnormal fibrous membrane. The degree is different. From the Treitz ligament to all or part of the small intestine of the terminal ileum, it is wrapped into a mass, horseshoe-shaped or U-shaped, and the capsule has no adhesion to the adjacent wall peritoneum. A small number of fusion with the pelvic wall or lateral peritoneum, part of which may involve the colon, stomach, gallbladder and uterus and accessories, the thickness of the capsule is uneven, the thickening is milky white, there may be loose adhesion between the small intestine or the capsule, and the stomach is separated. The capsule can be locally thickened, forming a narrowing ring or a band to compress the intestine to form an obstruction. The incidence of intestinal obstruction is about 57%, and the rate of abdominal hernia with intra-abdominal malformation is high, about 54.3%. The common omentum is common. Absence or hypoplasia, lack of left hepatic lobe, free cecum, etc., the results of pathological examination of abdominal hernia can be two cases:
1 fibrous collagen tissue showed chronic inflammation changes,
2 Peritoneal tissue comprehensive data analysis pathological changes, the capsule may be derived from peritoneal tissue.
Prevention
Abdominal hernia prevention
The cause of abdominal cramps is unknown, there is no effective prevention method
Complication
Abdominal complications Complications, intestinal obstruction
Intestinal obstruction is the main complication of this disease, and it is also the main reason for patients to see a doctor.
Symptom
Symptoms of abdominal cramps Common symptoms Abdominal pain, abdominal pain, nausea, vomiting, abdominal mass, peritonitis
Ordinary patients are asymptomatic, 92% of patients with intestinal obstruction, including subacute and chronic intestinal obstruction accounted for 71.4%, some patients occasionally found this disease during abdominal surgery, some patients with abdominal mass, the incidence rate of 69 %, Francis believes that the clinical features of this disease are:
1 young women with unexplained intestinal obstruction,
2 There is a similar history of seizures, which can be relieved by itself.
3 often manifests as abdominal pain and vomiting, but lacks four typical symptoms of intestinal obstruction,
4 palpation of the abdomen with or without tender mass, soft texture.
Abdominal hernia is difficult to diagnose before surgery, almost all of the intraoperative diagnosis. For adolescent women, there is no history of abdominal surgery and peritonitis or long-term medication, the incidence of intestinal obstruction and abdominal mass should be suspected.
Examine
Examination of abdominal cramps
Histopathological examination can be manifested as fibrous or collagenous tissue with chronic inflammatory changes.
1. B super suggestive that the tumor is a sticky intestinal tube, the external is weak echo tissue, can not observe the presence or absence of ascites and wrapped intestines with or without peristalsis.
2. X-ray barium meal examination can be seen in the small intestine compression, tightening, small intestine movement or ileal stenosis and other signs, the time of tincture through the small intestine is significantly prolonged, the contraction of the shortened mesentery and the inner wall of the fiber can make the small intestine appear similar to the colonic bag. Kind of sign.
3. CT can understand the small intestine in the abdominal block, and the narrowing of the intestine is wrapped by the thickened peritoneum.
Diagnosis
Diagnosis and diagnosis of abdominal cramps
Need to be differentiated from ovarian cysts, sclerosing peritonitis, tuberculous encapsulation peritonitis, and peritoneal tumors.
