fiber wrap
Introduction
Introduction Fiber membrane wrap, also known as "abdominal hernia", was named in 1978 and is a relatively rare disease in abdominal surgery. It is characterized in that all or part of the small intestine is covered by a dense, gray-white, tough, hard and thick fibrous membrane. Because of its different causes, clinical manifestations are different, and the understanding is also inconsistent. It has been reported as "small intestinal silkworm encapsulation, congenital small intestine imprisonment, small intestine stage fiber encapsulation, and intracapsular adhesive intestinal obstruction".
Cause
Cause
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 Caused by machine. 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 reproductive tract. However, these speculations have not been confirmed, and can not explain the incidence of male patients. It is found that intra-intestinal adhesions in the capsule are different from 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 The structure, the rate of malformation in the abdomen is higher (54.3%), often lacking in the omentum. It is speculated that the abnormal omental dysplasia or the small mesentery is caused by double-sleeve development, and the cause of intestinal adhesion in the capsule 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 noted that the incidence of abdominal cramps in patients with cirrhosis, nephritis, malignant tumors and heart failure with ascites is higher, especially in patients with cirrhosis after LeVeen shunt. Wang Ronghua reported a high incidence of tuberculous peritonitis.
Examine
an examination
Related inspection
Abdominal CT blood routine abdominal MRI examination abdominal blood vessel ultrasound examination
Normally, patients were asymptomatic, 92% of patients were treated with intestinal obstruction, and subacute and chronic intestinal obstruction accounted for 71.4%. Some patients occasionally found this disease during abdominal surgery. Some patients were accompanied by abdominal masses, with a prevalence 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.
Diagnosis
Differential diagnosis
It needs to be differentiated from peritoneal fibrosis, sclerosing peritonitis and peritoneal infection caused by tuberculous peritonitis.
(1) Peritoneal fibrosis caused by tuberculous peritonitis: manifested as extensive dense adhesion between the peritoneum and the intestine and the omentum. The omentum is thickened, contracted into a mass, suspended in the transverse colon, and the pathology shows a typical cheese-like appearance. Granuloma.
(2) peritoneal encapsulation: the small intestine is wrapped in a relatively normal peritoneum, and has no adhesion to the intestine. The source is the umbilical sac remaining in the embryonic development, which is a developmental abnormality.
(3) sclerosing peritonitis: mostly occurs in peritoneal dialysis, intraperitoneal chemotherapy, abdominal surgery, cirrhosis ascites and long-term use of pradolol, etc., full abdominal tightening, hard as a plate, peritoneal wall layer and total abdominal organs are widely adhered The intestinal tube adheres tightly and is difficult to separate.
Normally, patients were asymptomatic, 92% of patients were treated with intestinal obstruction, and subacute and chronic intestinal obstruction accounted for 71.4%. Some patients occasionally found this disease during abdominal surgery. Some patients were accompanied by abdominal masses, with a prevalence 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.
