OBJECTIVE: To explore the surgical treatment of abdominal callus and the problems that should be noted in postoperative management. METHODS: Eight patients with abdominal callus were treated surgically, and multiple methods were combined to promote the recovery of intestinal function after surgery. RESULTS: All 8 patients were cured and discharged from the hospital, and 1 patient had intestinal obstruction again after discharge, which was relieved after 2 days of gastrointestinal decompression. CONCLUSION: Surgical treatment for patients with abdominal callus is equally important as postoperative treatment to promote intestinal function recovery. Abdominal cocooning is a disease of unknown etiology, first reported and named by Foo in 1978. It is characterized by total or partial encapsulation of the abdominal organs in a fibrous membrane, resembling a cocoon. It is a relatively rare cause of intestinal obstruction that is mostly detected and reported by surgeons due to the occurrence of intestinal obstruction in clinical practice. A total of 8 cases were admitted to our hospital from September 2003 to July 2006, all of which were treated surgically and combined with a variety of postoperative treatments to achieve satisfactory results, which are summarized as follows. 1. Clinical data (1) General data: All 8 cases were male, aged 25-62 years old, average 45.3 years old, 3 cases with cryptorchidism, 1 case with large omental defect, 1 case with intestinal malrotation, hospitalization time 14-44 days, average 25.2 days. All patients had no history of abdominal surgery and no history of intubation, and the disease was discovered during dissection for intestinal obstruction. (2) Surgical situation: two patients had continuous epidural block, six patients had general anesthesia with endotracheal intubation, one patient had a left-sided dissection incision, and the other seven patients had a right-sided dissection incision. After the abdomen, the stomach, small intestine and colon were found to be covered by a white envelope, resembling a silk net, with the small intestine being the most serious, and one or more places forming a fibrous shrinkage ring or a mass of adhesions. Intestinal adhesion release was chosen as the surgical method, and intestinal alignment was not done, and adhesion flat was applied to the surface of the intestinal canal before closing the abdomen to prevent re-adhesion. The surgical excision of membrane-like tissue was sent for pathological examination, and the pathology reported that the membrane-like tissue was dense fibrous tissue with a few lymphocytes. (3) Postoperative treatment: In addition to conventional treatment such as gastrointestinal decompression, intravenous rehydration, anti-inflammation, nutritional support, stabilization of water, electrolyte and acid-base balance, etc., the patient was given 3-4 days after surgery when the anus was exhausted, i.e., when the gastrointestinal function was basically restored: ① Dexamethasone 5mg into the pot once a day. (ii) 100ml of raw soybean oil into the gastric tube 3 times a day. ③Intramuscular injection of neostigmine lmg once a day; or vitamin B,10 0mg once a day. (4) Chinese herbal medicine was given orally or injected through the gastric tube about 1 week after surgery. (4) Postoperative efficacy: 6 cases resumed eating semi-liquid 5-7 days after surgery and were discharged in 10-14 days. 1 case had intestinal obstruction again after eating in 9 days after surgery, and resumed eating in 20 days after surgery with conservative treatment, and was discharged in 26 days after surgery. In the other case, the amount of postoperative gastrointestinal decompression was more than 1000m1/d, and was discharged after conservative treatment on 37 days after surgery. (5) Follow-up results: 2 cases were lost and 6 cases were followed up. 4 cases were free of abdominal pain and other symptoms and were not complicated by intestinal obstruction. 1 case had intestinal obstruction again, which was relieved 2 days after gastrointestinal decompression. 1 case had indigestion from time to time in the early postoperative period, which was basically relieved after dietary regulation. 2.Discussion Abdominal callus is a rare disease, the cause of which is unknown. Because of its general anatomical features named differently, it is also known as chronic fibrous encapsulated peritonitis, encapsulated intestine, sugar-coated intestine, small intestine confinement, small intestine cocoon encapsulation disease. Most of the lesions are in the small intestine, but some include all organs of the abdominal cavity. (1) Etiology: It is generally believed that this disease is caused by a variety of factors. Congenital factors are attributed to congenital developmental anomalies, and the disease is associated with a high rate of intra-abdominal malformations, about 54.3%, commonly due to absence or hypoplasia of the greater omentum. Acquired factors such as meconium peritonitis, primary peritonitis, peritoneal chemotherapy, and long-term peritoneal dialysis treatment cause massive peritoneal fibrin exudation to form the peritoneal envelope. Tuberculous peritonitis can also lead to peritoneal cocooning. The disease may also be a sequela of subclinical peritonitis caused by retrograde infection with pathogens invading via the genital tract. In this group, one case was associated with large omental defect and one case was associated with intestinal dysplasia, which may be caused by congenital dysplasia. three cases were associated with cryptorchidism, presumably due to intrauterine fetal fecal occult infection leading to the formation of intra-abdominal adhesions, which prevented the testes from descending to the scrotum. (2) Treatment of abdominal cocooning: The principle of treatment for this disease is mainly surgery. If there are adhesions or narrowing rings, the adhesions should be fully loosened to solve the problem of intestinal obstruction. Small intestine without stenosis, generally not intestinal resection, and do not easily do the entire mass and its intestinal mix of excision, unless it has been clearly explored the mass contains organs for part of the small intestine, and there are difficulties in separation. The silk mesh (i.e. film) adhesions between the intestinal tubes do not hinder the patency of the intestinal cavity, but the local thickening of the peritoneum between the intestinal tubes to form a fiber narrowing ring to compress the intestinal tubes is the real cause of intestinal obstruction, which requires surgery to lift. (3) Several suggestions for postoperative management of abdominal cocooning: ①The daily application of small doses of corticosteroids is beneficial to reduce intestinal edema and promote the recovery of intestinal function. (2) Raw soybean oil is basically not absorbed by the intestine, which can play the role of adequate lubrication of the intestine and promote the discharge of intestinal contents. ③Intramuscular injection of neostigmine or vitamin B1 can promote intestinal peristalsis. ④Giving traditional Chinese medicine to clear dampness and heat, regulate qi and activate blood about 1 week after surgery seems to be helpful for intestinal function recovery. ⑤ One case in this group was cured after 37 days of conservative treatment after surgery, like this kind of intestinal obstruction that appeared again recently after surgery, because the thickened and dense adhesions were loosened during surgery, the adhesions formed again recently are still unstable, so there is no need to rush to operate again. Tissue repair changes can be lifted, so that patients do not have to suffer from surgery again. In conclusion, the surgical treatment of abdominal callus is an important step in this disease, but proper postoperative management is also an important component that should not be overlooked, as it can effectively reduce the patient’s pain, length of stay and hospitalization costs. As more and more cases of abdominal callus are discovered, more clinicians will have a deeper understanding of this condition and will contribute greatly to the recovery of patients with abdominal callus.