A Rare Case of Abdominal Cocoon Presenting as Umbilical Hernia

• Published in: Chinese medical journal 2015-05, Vol.128 (10), p.1415-1417
• Main Authors: Zhang, Yu, Liu, Wei-Dong, He, Jian-Tai, Liu, Qin, Zhai, Deng-Gao
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal Cocoon; Intestinal Obstruction; Laparoscopy Open Surgery; Umbilical Hernia; Adult; Appendectomy; Appendicitis; Case studies; Clinical Practice; Congenital diseases; Diagnosis; Disease; Family medical history; Hernia, Umbilical - diagnosis; Hernia, Umbilical - surgery; Hernias; Hospitals; Humans; Intestinal Obstruction - diagnosis; Intestinal Obstruction - surgery; Laparoscopy; Liver cirrhosis; Male; Medical diagnosis; Medical imaging; Pain; Peritoneal dialysis; Research centers; Small intestine; Studies; Surgery; Umbilical hernia
• ISSN: 0366-6999; 2542-5641
• DOI: 10.4103/0366-6999.156815

Even though preoperative diagnosis of AC is difficult and normally laparotomy is the main solution, in our case, we chose the method which combines laparoscopy with open surgery, it solved patient problem quickly and efficiently, and that further confirmed laparoscopic surgery has great significance in diagnosis and treatment of AC. The patient had inguinal hernia repair operation at 2-year-old, and he had no other special medical history, such as peritonitis, tuberculosis, or chronical drug intake. Computed tomography (CT) scan demonstrated umbilical hernia and an incomplete low small bowel obstruction without clear cause. [...]part of the bowel wall became thickening: A possible inflammatory lesions and pelvic effusion were involved as shown in [Figure 2]. [...]the clear diagnosis was AC. The coated surface was smooth and easy to separate from the intestinal wall, there was film adhesion seen in the apart small intestine [Figure 4]. The secondary form has been reported in associated with a history of previous abdominal surgery or peritonitis, prolonged use of practolol, chronic ambulatory peritoneal dialysis, ventriculoperitoneal shunts, intraperitoneal instillation of drugs, sarcoidosis, SLE, liver cirrhosis, hysteromyomas, ovarian endometriotic cyst or tumor, and tuberculous etiology. [2],[3] For this patient, although he underwent inguinal hernia surgery at a young age that was not enough to induce inflammation after so many years making peritoneal fibrin extensive sheep and forming capsular parcel causing AC, but with omentum majus absent, the cause of this case considered as congenital factors. [4] Surgery is the most fundamental way to solve laparoscopic surgery is really...