title: Surgical treatment and perioperative management of idiopathic abdominal cocoon: single-center review of 65 cases.
abstract: BACKGROUND
  The abdominal cocoon (AC) is a condition in which a variable length of healthy small bowel is enveloped in a fibrocollagenous membrane, giving the appearance of a cocoon. Early experiences with treatment were associated with high mortality and morbidity rates and a low preoperative diagnostic rate, leading to underestimation of the treatment benefit of surgery.
  
  
  METHODS
  We retrospectively reviewed the medical records of 65 patients who were diagnosed as having AC from 2001 to 2011. The clinical data, surgical intervention, and perioperative management were carefully reviewed.
  
  
  RESULTS
  The 65 patients (57 male, 8 female) had a median age of 39 years (range 14-79 years). Patients who received preoperative nutritional support had higher rate of grade 0 complications (p = 0.012) and a lower rate of grade II complications (p = 0.012) than those without nutritional support. Intestinal stenting during surgical intervention also decreased both grade I (p = 0.012) and grade II (p = 0.007) complications. Patients who received preoperative nutritional support and underwent intestinal stenting had a lower rate of postoperative complications (p < 0.05). In addition, patients with preoperative nutritional support were more satisfied postoperatively (p = 0.018) than those without nutritional support. This was also observed in patients with intestinal stenting versus those without it (p = 0.027).
  
  
  CONCLUSIONS
  Our single-center study with a large number of patients provided evidence regarding the epidemiology of AC. Preoperative nutritional support and intestinal stenting significantly reduced postoperative complications and, more importantly, increased postoperative satisfaction.
authors: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China.
authors: Ning
authors: N
authors: Li
authors: Weiming
authors: W
authors: Zhu
authors: Yi
authors: Y
authors: Li
authors: Jianfeng
authors: J
authors: Gong
authors: Lili
authors: L
authors: Gu
authors: Min
authors: M
authors: Li
authors: Lei
authors: L
authors: Cao
authors: Jieshou
authors: J
authors: Li
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000209:etiology; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D018529:Nutritional Support; D017060:Patient Satisfaction; D019990:Perioperative Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D015607:Stents; D014839:Vomiting / Q000209:etiology; D055815:Young Adult