Takemura M, Iwamoto K, Goshi S, Osugi H, Kinoshita H
Department of Surgery, Goshi Hospital, Amagasaki, Japan.
J Gastroenterol. 2000;35(1):52-5. doi: 10.1007/pl00009976.
We report case of primary volvulus of the small intestine and review 15 cases from the Japanese literature. A 56-year-old woman, with a history of appendectomy 30 years previously, was admitted with abdominal distension and signs of peritonitis. Abdominal computed tomography (CT) demonstrated a whirl-like pattern of the mesentery, showing the tightly twisted mesentery around the point of torsion. An emergency laparotomy revealed strangulation of the small intestine, from 200 cm anal to the Treitz ligament to 5 cm oral to the terminal ileum, caused by 360 degrees clockwise torsion. There was no adhesion caused by the previous operation nor were there any congenital anomalies. The strangulated intestine was removed and jejunocolonostomy was performed. The patient was discharged from hospital on day 39 after the operation. Primary volvulus of the small intestine was reported to be rare in Japan, but the mortality was 26%. Immediate diagnosis and surgical intervention is essential to achieve a good outcome. A whirl-like pattern of the mesentery is a typical sign of this condition on CT.
我们报告一例原发性小肠扭转病例，并回顾日本文献中的15例病例。一名56岁女性，30年前有阑尾切除术史，因腹胀和腹膜炎体征入院。腹部计算机断层扫描（CT）显示肠系膜呈漩涡状，显示扭转点周围系膜紧密扭转。急诊剖腹手术发现小肠绞窄，从距Treitz韧带肛侧200 cm至回肠末端口侧5 cm，由顺时针360度扭转引起。既往手术未造成粘连，也无先天性异常。切除绞窄肠段并进行空肠结肠吻合术。患者术后第39天出院。据报道，原发性小肠扭转在日本较为罕见，但死亡率为26%。立即诊断并进行手术干预对于取得良好预后至关重要。肠系膜呈漩涡状是CT上这种情况的典型征象。
