Adult malrotation: a case report and review of the literature.
Adult malrotation: a case report and review of the literature.
复制标题
DOI：
10.1016/s0149-7944(03)00030-8
复制
发表时间：
2003-09-01
期刊：
影响因子：
--
通讯作者：
Rothwell, Michael
中科院分区：
文献类型：
--
作者：
Gamblin, T Clark;Stephens, Richard E Jr;Rothwell, Michael
中肠旋转不良是一种异常的胎儿肠道旋转，通常出现在第一个月的生活。旋转不良在成年期出现是很罕见的。有症状的患者要么急性表现为肠梗阻和肠缺血伴中肠或盲肠扭转，要么慢性表现为不明显的腹痛。慢性症状通常会使诊断变得困难。旋转不良的诊断方法有多种，如钡剂检查、计算机断层扫描（CT）、血管造影和急诊剖腹手术。治疗仍采用拉德博士在1936年最初描述的拉德手术。急性梗阻或慢性腹痛的完全缓解是高度怀疑旋转不良、适当的诊断研究和积极的明确手术治疗的结果。我们提出一个病例旋转不良的成人谁提出了慢性腹痛。中肠旋转不良是一种先天性异常，指胎儿发育过程中，胎儿肠道围绕上级肠系膜动脉轴旋转不足或不完全。大多数病人在出生后的第一个月表现为胆汁性呕吐，原因是十二指肠梗阻或肠扭转。这种情况在成年期很少见。成人的真实发病率很难估计，因为大多数留下来的患者没有症状，因此他们的病情从未得到诊断。von Flue等人的文献综述引用了1923年至1992年的40例病例。有症状的患者常表现为急性肠梗阻和肠缺血伴中肠或盲肠扭转，或慢性不明腹痛。这些症状是由腹膜带引起的，最早由拉德于1932年描述。这些带从盲肠延伸到右侧腹壁。我们提出一个病例旋转不良的成人谁提出了慢性腹痛。
Midgut malrotation is an anomaly of fetal intestinal rotation that usually presents in the first month of life. It is rare for malrotation to present in adulthood. Symptomatic patients present either acutely with bowel obstruction and intestinal ischemia with a midgut or cecal volvulus, or chronically with vague abdominal pain. Chronic symptoms can often make the diagnosis difficult. Findings diagnostic of malrotation are described using several modalities such as barium studies, computed tomography (CT) scans, angiography, and often emergent laparotomy. Treatment remains the Ladd procedure originally described by Dr. Ladd in 1936. Complete resolution of acute obstruction or chronic abdominal pain is the result of a high index of suspicion for malrotation, appropriate diagnostic studies, and aggressive definitive surgical treatment. We present a case of malrotation in an adult who presented with chronic abdominal pain. Midgut malrotation is a congenital anomaly referring to either lack of or incomplete rotation of the fetal intestines around the axis of the superior mesenteric artery during fetal development. Most patients present with bilious vomiting in the first month of life because of duodenal obstruction or a volvulus. It is rare for this condition to present in adulthood. The true incidence in adults is difficult to estimate because most patients who remain are asymptomatic and their conditions are, therefore, never diagnosed. A literature review by von Flue et al cites 40 cases from 1923 to 1992. Patients who are symptomatic often present either acutely with bowel obstruction and intestinal ischemia with a midgut or cecal volvulus or chronically with vague abdominal pain. These symptoms are caused by peritoneal bands first described by Ladd in 1932. These bands run from the cecum to the right lateral abdominal wall. We present a case of malrotation in an adult who presented with chronic abdominal pain.