儿童腹茧症合并绞窄性肠梗阻一例

    洪志华章功年

    【摘要】腹茧症临床罕见，缺乏特异性的临床表现，术前明确诊断困难。该文报道了1例腹茧症合并绞窄性肠梗阻患儿，以脐周及右侧腹部疼痛伴恶心收入院，经实验室、影像学检查及急诊腹腔镜探查诊断为“绞窄性肠梗阻”，中转开腹手术，术中发现患儿右中腹部有部分小肠被一层淡黄色、质地坚韧的纤维膜包裹，形成团块状结构，呈茧状，诊断为腹茧症、绞窄性肠梗阻，予切除全部茧状腹膜、松解粘连、解除梗阻等，术后10 d患儿胃肠功能基本恢复。该例诊治经过提示，影像学检查如腹部立位X线平片、超声、CT等有助于提高本病的诊断，但需手术及病理学检查确诊。以手术治疗为主的综合治疗是腹茧症的主要治疗方式，切除包膜、松解粘连、解除梗阻是治疗本病的有效方法。儿童腹茧症虽是罕见的腹膜疾病，如治疗得当，预后良好。

    【关键词】腹茧症；临床表现；治疗；儿童

    收稿日期：(2015-04-26)

    Abdominal cocoon complicated with strangulated intestinal obstruction: a case reportHongZhihua,ZhangGongnian.DepartmentofPediatricSurgery,JiaxingMaternityandChildHealthCareHospital,Jiaxing314000,China

    Abstract【】Abdominal cocoon is rare in clinical practice and lacks specific clinical manifestations. It is difficult to make a definite diagnosis before surgery. We reported one child diagnosed with abdominal cocoon complicated with strangulated intestinal obstruction. The patient was admitted to our hospital due to periumbilical and right abdominal pain and nausea. The child was diagnosed with strangulated intestinal obstruction by laboratory, imaging examinations and emergency laparoscopy. During open surgery, partial small intestine was found to be covered by yellow fibrous membrane with hard texture in cocoon shape. Then, the child was diagnosed with abdominal cocoon complicated with strangulated intestinal obstruction. The abdominal cocoon mass was resected, the adhered tissues were separated and the intestinal obstruction was treated. The gastrointestinal function almost recovered at 10 d after operation. The diagnosis and treatment of this case prompted that imaging tools, such as X-ray, ultrasound, CT scan, could enhance the accuracy of diagnosis. Surgery and pathology could confirm the diagnosis. Surgical procedures serve as the effective therapy. As a rare disease, abdominal cocoon yields good clinical prognosis if properly and timely treated. ......