Diagnosis and Surgical Treatment of Primary Abdominal Cocoon:Report of 12 Cases

  Objective  To summarize our experiences in the diagnosis and treatment of primary abdominal cocoon.

  Methods  The clinical data of 12 patients with abdominal cocoon who were treated in the general surgery department of Peking Union Medical College Hospital from January 2002 to January 2012 were retrospectively analyzed.

  Results  Of these 12 patients, there were 8 males and 4 females. The main clinical manifestations included abdominal pain, abdominal distention, nausea, vomiting, and abdominal mass. Ultrasonography was the most frequent diagnostic approach. Computed tomography (CT) was performed in 6 cases, among whom only one patient was considered to be with abdominal cocoon. All these 12 patients received surgical treatment and 8 of them underwent partial intestinal excisions. The postoperative exhaust time was (5.8±3.0) days; the time to foodtaking was (14.8±3.6) days; and the mean hospital stay was (28.2±6.5) days. The postoperative complications included delayed gastric emptying (n=6), abdominal infection (n=4), and anastomotic fistula (n=2). Three patients (25%) died after the surgery due to sever infection and the remaining patients were followed up for 16 months (mean). Six patients well recovered, whereas the remaining 3 patients had incomplete intestinal obstruction and were given conservative treatment.

  Conclusion  The preoperative diagnosis of abdominal cocoon remains challenging. Abdominal ultrasonography is the most commonly applied examination, and enhanced CT may facilitate the diagnosis. Surgery should be performed for patients with recurrent acute or chronic intestinal obstruction.