Abdominal koza sendromu: Akut karýn sendromunun nadir bir nedeni

AMAÇ: Literatürde nadir görülen bir akut karýn veya baðýrsak týkanýklýðý nedeni, abdominal koza sendromu sklerozan peritonit veya sklerozan enkapsüle peritonit olarak tanýmlanmaktadýr. Abdominal koza, karýn organlarýnýn lifli bir zar ile tamamen veya kýsmen sarýlmasý ile karakterizedir. Genellikle genç kadýnlarda görülmesine raðmen etiyoloji bilinmemektedir. Taný genellikle laparotomi sýrasýnda yapýlýr. Bu yazýda, operasyon sýrasýnda abdominal koza tanýsý almýþ yedi hasta sunuldu.
GEREÇ VE YÖNTEM: Hastanemiz genel cerrahi kliniðinde Ocak 2012 ile Kasým 2018 tarihleri arasýnda karýn aðrýsý ve/veya baðýrsak týkanýklýðý nedeniyle laparotomi yapýlan ve ameliyat sýrasýnda abdominal koza tanýsý alan hastalarýn kayýtlarý geriye dönük olarak incelendi. Hastalarýn demografik özellikleri, altta yatan etiyolojik faktörler, cerrahi iþlemler, bulgularý ve takipleri kaydedildi.
BULGULAR: Abdominal koza nedeniyle ameliyat edilen 7 hastadan dördü erkek, 3’ü kadýndý. Ortanca yaþ erkeklerde 61 (57-63), kadýnlarda 39.6 (28-49) idi. Akut karýn veya ileus tanýsý ile altý hasta acil durumlarda ameliyat edildi. Elektif koþullarda karýn içi kitle tanýsý alan bir hasta ameliyat edildi. Yedi hastadan beþinde, ince baðýrsaklarýn tamamý bir fibrokollajen kapsül ile kaplýyken, 2 hastada baðýrsaklar kýsmen fibrokollajen kapsül ile kýsmen sarýldý. Hastalarýn dördünde altta yatan hastalýk yoktu, bir tanesinde Ailesel Akdeniz Ateþi (AAA), birinde endometriozis, birisinde beta-bloker kullanýmý vardý. Ameliyat sýrasýnda ince baðýrsak nekrozu ve septik peritonit saptanan hasta 6 gün sonra kaybedildi. Diðer hastalarýn takibinde komplikasyon görülmedi ve hiçbir hasta nüks nedeniyle tekrar ameliyat edilmedi.
TARTIÞMA: Abdominal koza, akut karýn veya baðýrsak týkanmasý gibi nedenlerle ameliyat edilen hastalarda genellikle ameliyat sýrasýnda teþhis edilen bir durumdur. Geç taný konulan olgularda ince baðýrsak nekrozu ve septik komplikasyonlar nedeniyle ölüm görülebilir. Preoperatif tanýda yüksek klinik þüphe ve radyolojik görüntüleme önemlidir. Tedavi, fibrokollajen membranýn eksizyonu ve adezyolizisdir.

Abdominal cocoon syndrome: A rare cause of acute abdomen syndrome

BACKGROUND: A rare cause of acute abdomen or intestinal obstruction, the abdominal cocoon syndrome is also described in the literature as sclerosing peritonitis or sclerosing encapsulating peritonitis. Abdominal cocoon is characterized by the total or partial wrapping of the abdominal organs by a fibrous membrane. Although it is usually observed in young women, the etiology is unknown. The diagnosis is usually made during laparotomy. In this case series, we aimed to present seven patients diagnosed with abdominal cocoon syndrome during operation.
METHODS: The records of patients who underwent laparotomy for abdominal pain and/or intestinal obstruction in our hospital and diagnosed as abdominal cocoon during operation between January 2012 and November 2018 were retrospectively reviewed. The demographic characteristics of the patients, etiologic factors, surgical procedures, operative findings and follow-up of the patients were recorded.
RESULTS: Four out of seven patients who were operated for abdominal cocoon were male and 3 of them were female. The median age of patients was 61 (57–63) years in male and 39.6 (28–49) years in female. Six of the patients were operated in emergency conditions with the diagnosis of an acute abdomen or ileus. One of the patients was operated with the diagnosis of an intra-abdominal mass in elective conditions. In five out of seven patients, all of the small intestines were wrapped with a fibrous collagen capsule, while two of the patient intestines were partially wrapped with a fibrous collagen capsule. Four of the patients had no underlying disease, while one of the patients had Familial Mediterranean Fever (FMF), one had Endometriosis and one had beta-blocker medication. One patient who had small bowel necrosis and septic peritonitis were observed during the operation and died post operative 6th days. Postoperative complications were not observed in the follow-up of other patients and reoperation was not required due to recurrence.
CONCLUSION: Abdominal cocoon is a condition that is usually diagnosed during operation in patients that were operated for reasons, such as the acute abdomen or intestinal obstruction. When the diagnose delayed, death can be seen due to small bowel necrosis and septic complications. High clinical suspicion and radiological imaging are important in the preoperative diagnosis. Treatment is required adhesiolysis and excision of the fibrous membranes.