Intestinal malrotation - A rare but important cause of bowel obstruction in adults
Intestinal malrotation - A rare but important cause of bowel obstruction in adults
复制标题
DOI：
10.1007/s10350-004-6429-0
复制
发表时间：
2002-10-01
影响因子：
3.9
通讯作者：
Vogt, DP
中科院分区：
文献类型：
--
作者：
Dietz, DW;Walsh, RM;Vogt, DP
目的：肠旋转不良的并发症对儿科外科医生来说很常见，但在那些严格照顾成年人的人中很少遇到。这项研究的目的是回顾我们在成人患者中治疗肠旋转障碍的经验，并强调其临床表现、放射学特征和手术治疗的结果。方法：10例成人肠旋转不良患者，年龄22~73岁，平均42岁。记录临床表现、手术治疗和结果。结果：9例患者出现梗阻症状(慢性5例，急性4例)。所有病例术前均通过小肠对比检查或CT扫描确诊为旋转不良。采用剖腹粘连松解术4例(其中十二指肠旁疝1例，中肠扭转2例)，Lade手术4例，十二指肠固定术+盲肠固定术1例。一名患者出现急腹症，并被发现患有阑尾炎。没有死亡病例。两名患者出现并发症(伤口感染和肠梗阻)。2例患者出现肠梗阻复发，平均随访30个月(2-69个月)，1例需要再次手术。结论：肠旋转并发症可发生在成人患者中，可表现为慢性或急性症状。及时的识别和手术治疗通常会导致成功的结果。任何有小肠梗阻症状和体征的成人患者都应考虑诊断为肠旋转不良。
PURPOSE: Complications of intestinal malrotation are familiar to pediatric surgeons but are rarely encountered by those caring strictly for adults. The aim of this study was to review our experience with disorders of intestinal rotation in adult patients and to emphasize the clinical presentation, radiographic features, and results of surgical treatment. METHODS: Ten adult patients (mean age, 42 (range, 22-73) years) with complications of intestinal malrotation were identified by review of department records. Clinical presentation, operative treatment, and outcome were recorded. RESULTS: Nine patients presented with obstructive symptoms (five chronic and four acute). A diagnosis of malrotation was made preoperatively in all cases by a small-bowel contrast study or CT scan. Patients were treated by laparotomy with adhesiolysis (4 cases including one paraduodenal hernia and two midgut volvuli), Ladd's procedure (4 cases), or duodenopexy and cecopexy (1 case). One patient presented with an acute abdomen and was found to have appendicitis. There was no mortality. Two patients developed complications (wound infection and ileus). Two patients had recurrent episodes of small-bowel obstruction with a mean follow-up of 30 (range, 2-69) months and one required reoperation. CONCLUSIONS: Complications of intestinal rotation can occur in adult patients and may present with chronic or acute symptoms. Prompt recognition and surgical treatment usually lead to a successful outcome. The diagnosis of intestinal malrotation should be considered in any adult patient with signs and symptoms of small-bowel obstruction.