Millar A J W, Rode H, Cywes S
Department of Paediatric Surgery, School of Child and Adolescent Health, University of Cape Town and Red Cross Children's Hospital, Rondesbosch, South Africa.
Semin Pediatr Surg. 2003 Nov;12(4):229-36. doi: 10.1053/j.sempedsurg.2003.08.003.
The subject of malrotation and midgut volvulus in infancy and childhood is reviewed from the perspective of experience with 138 patients evaluated in a published series and a further 82 cases seen since. Embryology, historical aspects, clinical presentation, investigation, surgery, and outcome are discussed. The diagnosis of malrotation and volvulus should always be kept in mind when assessing any infant or child with symptoms of vomiting and pain, particularly when the vomiting is bile-stained. The diagnosis cannot be excluded if diarrhea is present, when clinical findings are bland, or even with normal abdominal radiographs. A contrast meal and follow-through should be done and, if correctly interpreted, should be diagnostic. Ultrasound examination may be helpful but is not secure enough to exclude the diagnosis. Laparotomy or laparoscopy is the only way to be sure. Malrotation with its propensity for volvulus is truly a time bomb lying within.
从已发表系列中评估的138例患者以及此后所见的另外82例病例的经验角度，对婴儿期和儿童期肠旋转不良及中肠扭转的主题进行了综述。讨论了胚胎学、历史方面、临床表现、检查、手术及预后。在评估任何有呕吐和疼痛症状的婴儿或儿童时，尤其是呕吐物为胆汁样时，应始终牢记肠旋转不良和扭转的诊断。当存在腹泻、临床症状不明显甚至腹部X线平片正常时，也不能排除该诊断。应进行上消化道造影及钡剂通过检查，若解读正确，应具有诊断价值。超声检查可能有帮助，但不足以可靠地排除诊断。剖腹探查术或腹腔镜检查是确诊的唯一方法。肠旋转不良及其发生扭转的倾向确实是一颗隐藏在体内的定时炸弹。
