ACUTE AND CHRONIC PRESENTATION OF INTESTINAL NONROTATION IN ADULTS
ACUTE AND CHRONIC PRESENTATION OF INTESTINAL NONROTATION IN ADULTS
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DOI：
10.1007/bf02047549
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发表时间：
1994-02-01
影响因子：
3.9
通讯作者：
HARDER, F
中科院分区：
文献类型：
--
作者：
VONFLUE, M;HERZOG, U;HARDER, F
肠不旋转被认为是新生儿和儿童肠梗阻的一个原因，可能并发肠扭转和肠坏死。它在成人中非常罕见，急性时可能表现为肠梗阻和肠缺血，伴有中肠或回盲部扭转，慢性时可能表现为不明确的间歇性腹痛。本文的目的是揭示成人肠不旋转的发病机制和手术意义，并回顾自1923年以来的英语和德语文献，以建立最佳的治疗管理。在1983年至1992年期间，我们对10例肠不旋转的成人进行了前瞻性的管理和观察。在四个病人的不旋转已被发现在紧急剖腹手术，由于中肠或回盲部扭转。四名患者患有慢性症状的间歇性肠扭转或小肠梗阻，并在两名患者的不旋转已注意到作为一个偶然发现，在剖腹手术的另一种情况。从1923年至1992年的文献调查显示，40名成人有症状的肠不旋转，我们贡献了9例患者。我们认为，在急性症状型，只有紧急剖腹手术可以提供正确的诊断和减少肠道紊乱的风险。在慢性情况下，上消化道和下消化道的钡剂检查显示不同程度的中肠旋转不良，并证实每例病例的不旋转。此外，在这些形式的剖腹探查术，从而分期腹部部位是建议。我们机构报告的所有病例在手术后都没有投诉。有肠不旋转和急性或慢性梗阻症状的成年患者，或因其他原因在剖腹手术时偶然发现的患者，应接受拉德手术，因为有中肠扭转的风险。在这个手术中，不旋转保留在原位，升结肠在降结肠和乙状结肠处缝合。手术后，肠系膜蒂固定，中肠扭转的风险仍然很小。
Intestinal nonrotation has been recognized as a cause of obstruction in neonates and children and may be complicated by volvulus and intestinal necrosis. It is very rarely seen in the adult and may present acutely as a bowel obstruction and intestinal ischemia associated with midgut or ileocecal volvulus, or chronically as vague intermittent abdominal pain. The purpose of this communication is to reveal the pathogenesis and the surgical significance of intestinal nonrotation in adults and to review the English and German language literature since 1923 to establish the optimal therapeutic management. Between 1983 and 1992, we have managed and observed prospectively 10 adults with intestinal nonrotation. In four patients the nonrotation has been detected at emergency laparotomy owing to midgut or ileocecal volvulus. Four patients suffered from chronic symptoms of intermittent volvulus or small bowel obstruction and in two patients the nonrotation has been noted as an incidental finding at laparotomy for another condition. A survey of the literature from 1923 to 1992 revealed 40 adults with symptomatic intestinal nonrotation to which we contribute nine patients. We establish that in the acute symptomatic pattern, only emergency laparotomy can provide the correct diagnosis and decrease the risk of bowel disturbance. In the chronic situation, barium studies of the upper and lower gastrointestinal tract reveal varying degrees of midgut malrotation and confirm the nonrotation in each case. Also, in these forms the explorative laparotomy with a consequent staging of the abdominal situs is to be recommended. All reported cases at our institutions are without complaints after surgery. Adult patients with intestinal nonrotation and acute or chronic obstructive symptoms or those detected incidentally at laparotomy for other conditions should undergo a Ladd procedure because of the risk of midgut volvulus. In this operation, the nonrotation is left in place and the ascending colon is sutured at the colon descendens and sigmoideum. After this procedure the mesenteric pedicle is fixed and the risk of midgut torsion remains minimal.