Late presentation of intestinal malrotation: An argument for elective repair
Late presentation of intestinal malrotation: An argument for elective repair
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DOI：
10.1007/s00268-008-9490-3
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发表时间：
2008-07-01
影响因子：
2.6
通讯作者：
Jeyarajah, D. Rohan
中科院分区：
文献类型：
--
作者：
Moldrem, Amy W.;Papaconstantinou, Harry;Jeyarajah, D. Rohan
背景：中肠旋转不良最常见于幼儿。这种诊断通常不适用于有腹部主诉的青少年或成年人。方法回顾1993-2004年间收治的青少年或成人肠固定或旋转不良患者的病历资料。结果33例患者均诊断为肠固定或旋转不良，均行Lade手术治疗。50%的患者存在急性腹痛，其他患者存在慢性主诉。最初的检查包括CT扫描(28%)、上消化道(UGI)检查(38%)和平片(47%)。急诊手术组(60%)的术后并发症发生率(60%)高于择期手术组(22%；P=0.04)。此外，研究结果还表明，已知的旋转不良患者应该选择性地而不是紧急地进行Lade手术。
Background Midgut malrotation most commonly presents in young children. This diagnosis is not often entertained in the adolescent or adult with abdominal complaints. We reviewed our experience with this subset of malrotation patients.Methods A retrospective review of medical records from adolescent or adult patients identified with a diagnosis of anomaly of intestinal fixation or malrotation, who were treated within our health system between 1993 and 2004.Results A total of 33 patients were diagnosed with malrotation and treated with Ladd's procedure. Acute abdominal pain was present in 50%, and chronic complaints were present in the other patients. Initial work-up included computed tomography (CT) scan (28%), upper gastrointestinal (UGI) study (38%), and plain films (47%) Postoperative complications occurred more frequently in patients that were operated on emergently (60%) than in those that underwent elective surgery (22%; p = 0.04).Conclusions This large case series of intestinal malrotation in the nonpediatric age group suggests that Ladd's procedure can be performed very safely. Moreover, the results suggest that patients with known malrotation should have Ladd's procedure performed electively rather than urgently.