Croitoru D, Neilson I, Guttman F M
Department of Surgery, Montreal Children's Hospital, Quebec, Canada.
J Pediatr Surg. 1991 Nov;26(11):1276-8. doi: 10.1016/0022-3468(91)90597-m.
Three cases of pyloric stenosis associated with malrotation are presented. In one case, the diagnosis was made synchronously, and in two cases, pyloric stenosis was noted following correction of malrotation. All three patients underwent pyloromyotomy and Ladd's procedure. These cases differ from the few reported hereditary cases of pyloric stenosis associated with malrotation, which have congenitally shortened bowel, functional obstruction, and poor prognosis. The unusual finding of pyloric stenosis and malrotation occurring together in the first patient was diagnosed with upper gastrointestinal series, obtained because of a high index of suspicion despite a palpable pyloric tumor and positive ultrasound examination. The second and third cases illustrate that vomiting following Ladd's procedure may be due to pyloric stenosis. When clinical findings do not support the presumed diagnosis, further investigation prior to operation is recommended so that rare concommitant pathology can be corrected.
本文报告了3例与肠旋转不良相关的幽门狭窄病例。其中1例为同步诊断，另外2例在肠旋转不良纠正后发现幽门狭窄。所有3例患者均接受了幽门肌切开术和Ladd手术。这些病例与少数报道的与肠旋转不良相关的遗传性幽门狭窄病例不同，后者存在先天性肠管缩短、功能性梗阻且预后较差。首例患者中幽门狭窄与肠旋转不良同时出现这一不寻常发现，是通过上消化道造影诊断的，尽管可触及幽门肿物且超声检查呈阳性，但由于高度怀疑而进行了该项检查。第2例和第3例病例表明，Ladd手术后的呕吐可能是由幽门狭窄引起的。当临床检查结果不支持推测的诊断时，建议在手术前进一步检查，以便纠正罕见的合并病变。
