Diagnosis and treatment of abdominal cocoon: a report of 24 cases.
BACKGROUND
Abdominal cocoon (AC) is a rare disease characterized by total or partial encasement of the small bowel by a thick, fibrous membrane. Twenty-four cases are reported in this article. Our aim was to investigate the methods of diagnosis and treatment for AC.


METHODS
The clinical manifestations, diagnoses, surgical treatments, and follow-up results of 24 cases of AC in the Department of General Surgery of the Third Affiliated Hospital of Sun Yat-sen University between January 1997 and September 2007 were retrospectively analyzed.


RESULTS
Main clinical manifestations were partial or complete intestinal obstruction (87.5%) and abdominal mass (54.2%). Three cases were preoperatively diagnosed by computed axial tomography and 1 case by barium x-ray examination. The other 20 cases were diagnosed by laparotomy. All of the patients underwent surgery. In all cases, we found that part of or the entire small bowel was encapsulated in a dense, white, fibrous, cocoon-like membrane. During surgery, excision of the thick membrane and lysis of adhesions were carefully performed to release the small intestine. Postsurgical recovery in most cases was smooth, and there was no recurrence during a follow-up period of 3 months to 9 years (mean 37 months).


CONCLUSIONS
The clinical manifestation of AC is nonspecific; therefore, preoperative diagnosis is difficult. However, its manifestations on barium x-ray and contrast computed axial tomography scan are characteristic, and aggregate analysis of the clinic and radiologic data can increase preoperative diagnosis. The main treatment of AC is surgery, and the overall prognosis of these patients is satisfactory.
Wei
Bo
B
Department of Gastrointestinal Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Wei
Hong-Bo
HB
Guo
Wei-Ping
WP
Zheng
Zong-Heng
ZH
Huang
Yong
Y
Hu
Bao-Guang
BG
Huang
Jiang-Long
JL
D034841:Abdominal Cavity / Q000601:surgery; D000293:Adolescent; D000328:Adult; D001466:Barium Sulfate; D003287:Contrast Media; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000601:surgery*; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D003287:Contrast Media; D001466:Barium Sulfate