Abdominal cocoon (abdominal cocoon) is a rare abdominal disease, the cause of which is unknown and difficult to diagnose preoperatively. It is characterized by the total or partial cocooning of the small intestine within an abnormal fibrous membrane, and the treatment is mainly surgical. There are various clinical manifestations of abdominal callus, also called small bowel confinement, small bowel cocoon encapsulation, primary sclerosing peritonitis, limited small bowel encapsulation, idiopathic sclerosing peritonitis, small bowel segmental fibrous encapsulation and sugar-coated bowel. Since the wrapped organs are not only the small intestine, but sometimes the colon, uterus and adnexa, and the organs as a whole are extraperitoneal organs, it is more appropriately called abdominal cocooning. The etiology of abdominal callus is not clear, one includes 1, congenital anomalies. 2, recurrent inflammation of the abdominal cavity. 3, the influence of drugs. 4, primary peritonitis. There may be a relationship between the higher incidence of abdominal callus in patients with cirrhosis, trauma, malignancy and cardiac failure with ascites. Due to foreign body irritation in the abdominal cavity, it causes increased fibrin exudation followed by mechanization to form a fibrous peritoneum. It indicates that the development of abdominal callus is related to the acute and chronic inflammation of the abdominal cavity caused by the stimulation of abdominal injury, which may be one of the factors in the development of abdominal callus. Release] The patient’s intra-abdominal fibrous membrane is cocoon-like, creamy white or yellowish, with a smooth surface, starting from the flexor ligament, the mesenteric root or the lesser omentum, and ending at the middle and lower ileum, the end or the pelvic organs, partially adherent to the anterior abdominal wall, and the subdiaphragmatic space disappears. The thickness of the fibrous membrane was mostly between 1-12 mm, tough and easy to loosen, and multiple intestinal pressure marks were visible on the intestinal surface of the fibrous membrane after loosening. After separation of the loose adhesions between the intestines, the plasma membrane of the small intestine was smooth and the intestinal wall was flexible as usual. The fibrous membrane is partially sclerotic with glass-like lesions, and the interstitial small blood vessels are congested and dilated with lymphocyte infiltration. Clinical manifestations The clinical manifestations of abdominal callus have the following points: ① young patients are more frequent, and there is no significant difference in the incidence ratio between men and women; ② no previous history of surgery, with unexplained intestinal obstruction or constipation; ③ history of recurrent abdominal pain, nausea and abdominal distension, but only some patients also have stopped defecation and exhaustion, i.e., only partial clinical manifestations of intestinal obstruction, lacking the four major features of typical intestinal obstruction, non-surgical treatment is effective, and sometimes Some patients show asymptomatic abdominal masses, which are mostly round, slightly moving, and can be compressed, and intestinal sounds can be heard on the surface. Abdominal cocooning is a rare surgical condition with no specific clinical manifestations and can be asymptomatic for life, and is often detected due to intestinal obstruction, abdominal masses or in combination with other diseases. Diagnosis Although it has been repeatedly reported in recent years at home and abroad, the diagnosis of this disease is difficult due to the lack of standardized clinical diagnostic criteria, especially the preoperative diagnosis is rarely confirmed. At least the following points must be met: ① part or all of the small intestine is wrapped by the fibrous membrane; ② the fibrous membrane is continuous and intact; ③ the fibrous membrane is an independent structure and there are separable planes between the wrapped small intestine; ④ the pathological tissue type of the envelope is fibrous tissue; ⑤ whether the large omentum is absent should be used as an auxiliary but not necessary basis for diagnosis. In addition to clinical manifestations, the diagnosis of abdominal cocooning is based on the following auxiliary examinations: ① X-ray examination mainly shows signs of partial intestinal obstruction, such as small intestine collection with stepped liquid and gas planes, and sometimes dilated intestinal collaterals are visible; ② barium meal examination of the gastrointestinal tract can reveal a curled or round-trip coiled part or all of the small intestine other than the duodenum within the mass, with restricted mobility, and the intestine cannot be easily separated after pressure is applied, and pushing the mass The sensitivity of CT diagnosis is greater than 81, which shows round or ovoid mass foci with envelope at the edge, smooth outer edge, no adhesion with the wall peritoneum, and intestinal tube in and out of the site, and tangled mesenteric vascular cross-sectional image can be seen in the upper posterior of the mass. The curled and arranged small intestine was seen to be “bead”-like, with low mixed density due to the presence of food and gas in the intestinal lumen. In the absence of intestinal obstruction, the oral positive contrast agent can fill the intestinal lumen of the cocoon, and in the case of combined intestinal obstruction, the contrast agent can only reach the outer edge of the cocoon; ⑤ MRI multi-parameter and multi-directional imaging can directly show the hypertrophic and tortuous intestinal tube, the gas and fluid in the intestinal lumen and the adhesion with the large omentum; ⑥ pathological examination shows that the envelope is dense fibrin-like membranous tissue, partly with glassy degeneration, without epithelial cells, non-specific inflammation of the fibers, and a small infiltration of leukocytes and lymphocytes. The symptoms and signs of abdominal cocooning are nonspecific and asymptomatic in general, but when certain factors, such as inflammation of abdominal organs, ingestion of indigestible food, and postural changes after a full meal, can cause inflammatory edema thickening of the intestinal canal, increased contents of the intestinal canal, mutual extrusion, and excessive folding of intestinal collaterals while the peritoneum restricts the movement of the intestinal canal, surgical emergencies such as acute intestinal obstruction are induced and preoperative diagnosis is difficult. Intraoperative diagnosis can reveal the specificity of the disease, the fibrous membrane is more transparent and uniform, widely wrapped around the intra-abdominal organs, and the natural arrangement of intestinal tubes is clearly visible, which is obviously different from intra-abdominal adhesions caused by inflammation, surgery, trauma and perforation in the abdominal organs, and can be easily differentiated. Treatment The treatment of abdominal cocooning is mainly surgical, in principle, complete excision of the peritoneum, release of adhesions and removal of the cystic band. Recently, scholars have advocated that there is no need to deliberately pursue complete excision and extensive separation of the peritoneum. Although some scholars advocate that non-surgical treatment should be carried out as far as possible for abdominal callus, this disease often has no obvious symptoms, mostly combined with other diseases with acute onset, and the diagnosis is not clear at the time of admission, and more surgical treatment is carried out. The treatment principles of abdominal callus are analyzed as follows: ① preoperative diagnosis or suspected abdominal callus, to try to non-operative treatment. Because the more the number of surgical release of adhesions, the more difficult it is to release the adhesions, the greater the difficulty of surgery, the more chances of injury to abdominal organs and complications, ② patients with obvious symptoms and poor conservative treatment should be actively treated surgically, we should try to find the site of adhesions causing obstruction to be released, adhesions that do not cause obstruction can not be dealt with, if you can not be sure that the obstruction is lifted to be completely released; ③ because the peritoneum and It is difficult to separate and excise because of the fusion of peritoneum and intestinal tube, and it is easy to adhere to the obstruction again, so only the peritoneum can be loosened to release the obstruction. ④If there is no lesion in the intestinal canal, intestinal resection should not be performed, and the small intestine in the package should not be removed as a tumor to avoid short bowel syndrome; ⑤It is controversial whether to perform small intestine arrangement after small intestine package release, but small intestine arrangement may cause small intestine adhesion into a group and package regeneration; ⑥Even if there is no appendiceal lesion, if the patient’s condition allows, the appendix can be removed at the same time without increasing the difficulty of surgery to avoid (6) even if there is no appendiceal lesion, if the patient’s condition allows, the appendix can be removed at the same time without increasing the difficulty of surgery, so that the patient will not have further appendiceal lesions and the resulting intestinal obstruction, which will increase the chance of surgery; (7) before closing the abdomen, appropriate amount of substances to prevent or reduce intestinal adhesions, such as medium molecular dextrose, sodium hyaluronate, chitosan and sterile paraffin, can be injected into the abdominal cavity to prevent the re-formation of encapsulation. Postoperative patients should get out of bed early to promote early recovery of intestinal peristalsis and prevent intestinal adhesions; ⑧ Postoperative patients should not overeat, avoid eating cold and indigestible food, and avoid strenuous activities to prevent intestinal obstruction. It is recommended to combine Chinese and Western medicine after surgery to speed up the recovery and reduce the probability of recurrence in the future.