Colović R, Colović N, Zogović S
Institute of Digestive Diseases, Clinical Centre of Serbia.
Srp Arh Celok Lek. 2000 May-Jun;128(5-6):205-7.
Volvulus of the small bowel is not so frequent as is volvulus of the colon. A delayed diagnosis and surgical treatment result in high rate bowel infarction which can lead to perforation and stercoral peritonitis. If perforation does not take place, the infarcted bowel has to be resected causing multiple complications and mortality. The small bowel volvulus is caused by mesenteric lipoma in about 5% of cases. We present a 77-year-old man operated on for intestinal obstruction. The patient was admitted in a serious condition with a five-day history of abdominal pain and vomiting. On admission he vomited a small bowel content (miserere), he was dehydrated and with high blood urea and creatinine values. Plain X-ray showed a number of air fluid levels in the small bowel. At operation a small bowel volvulus caused by mesenteric lipoma (18 x 11 x 10 cm in diameter) with bowel infarction but without free perforation and peritonitis, was found. The tumour was removed together with 10 cm of resected bowel with end-to-end anastomosis. The recovery was uneventful. The patient is still symptom free.
小肠扭转不如结肠扭转常见。诊断和手术治疗延迟会导致肠梗死发生率很高，进而可导致穿孔和粪性腹膜炎。如果未发生穿孔，梗死肠段必须切除，这会引发多种并发症并导致死亡。约5%的小肠扭转病例由肠系膜脂肪瘤引起。我们报告一名77岁因肠梗阻接受手术的男性患者。该患者入院时病情严重，有5天的腹痛和呕吐史。入院时呕吐出小肠内容物（胆汁），存在脱水，血尿素和肌酐值升高。腹部平片显示小肠有多个气液平面。手术中发现由肠系膜脂肪瘤（直径18×11×10 cm）引起的小肠扭转，伴有肠梗死，但无游离穿孔和腹膜炎。肿瘤连同10 cm切除肠段一并切除，并进行端端吻合。恢复过程顺利。患者至今仍无症状。
