Walsh D S, Crombleholme T M
Division of General and Thoracic Surgery, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, 19104, USA.
J Pediatr Surg. 2000 May;35(5):753-5. doi: 10.1053/jpsu.2000.6051.
Malrotation can be difficult to diagnose after the newborn period because of intermittent symptoms and vague clinical findings, but malrotation with midgut volvulus is usually quite striking in its presentation. Early diagnosis and surgical treatment are essential to prevent acute ischemic infarction of the bowel, although chronic complications are rare. The authors present an unusual case of mesenteric venous thrombosis secondary to chronic midgut volvulus. A 13-year-old girl presented with an 11-year history of recurrent bouts of abdominal pain evaluated at 3 other institutions without a diagnosis. At the referring hospital, an episode of bilious emesis associated with abdominal pain prompted a computerized tomography scan of the abdomen. This showed a calcified thrombus within the superior mesenteric vein (SMV). At laparotomy, malrotation with chronic 270 degree volvulus was found with evidence of mesenteric venous hypertension. Segmental occlusion was documented on magnetic resonance angiography. SMV thrombosis is an unusual complication of malrotation with chronic midgut volvulus.
由于症状间歇性发作且临床发现不明确，新生儿期后的旋转不良可能难以诊断，但伴中肠扭转的旋转不良通常表现相当明显。早期诊断和手术治疗对于预防肠道急性缺血性梗死至关重要，尽管慢性并发症很少见。作者报告了一例继发于慢性中肠扭转的肠系膜静脉血栓形成的罕见病例。一名13岁女孩有11年反复发作腹痛的病史，曾在其他3家机构就诊但未确诊。在转诊医院，一次与腹痛相关的胆汁性呕吐促使对腹部进行了计算机断层扫描。扫描显示肠系膜上静脉（SMV）内有钙化血栓。剖腹手术时发现有慢性270度扭转的旋转不良，并伴有肠系膜静脉高压的证据。磁共振血管造影显示有节段性闭塞。SMV血栓形成是慢性中肠扭转合并旋转不良的一种罕见并发症。
