Brown Craig, Numanoglu Alp, Rode Heinz, Sidler Daniel
Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital and University of Cape Town.
S Afr J Surg. 2009 Nov;47(4):127-30.
Fewer than 20 patients born with situs inversus and duodenal atresia have been reported in the literature. We present a patient with this condition. A newborn baby presented shortly after birth with persistent bilious vomiting. An abdominal radiograph showed a right-sided stomach bubble and a second bubble on the left - typical of duodenal atresia but with mirror image configuration. Laparotomy confirmed the diagnosis of situs inversus abdominalis, which was also demonstrated by contrast studies and ultrasound. Duodenoduodenostomy was performed and the patient discharged on day 8 postoperatively. Situs inversus is associated with other congenital malformations including splenic malformations, left-sided liver and cardiac abnormalities; it is rarely associated with duodenal atresia. Duodenal obstruction in the presence of situs inversus has been described, including obstruction due to a web, stenosis, pre-duodenal portal vein and complete atresia. The patient presented in this paper had a duodenal web in the second part of the duodenum. Before undertaking surgery it is important to establish the presence of associated gastrointestinal and cardiac abnormalities.
文献报道中出生时患有内脏反位和十二指肠闭锁的患者少于20例。我们报告了一名患有这种病症的患者。一名新生儿出生后不久即出现持续性胆汁性呕吐。腹部X线片显示胃泡在右侧，左侧还有一个气泡——这是十二指肠闭锁的典型表现，但呈镜像形态。剖腹手术证实为腹内脏器反位，造影检查和超声检查也证实了这一点。实施了十二指肠十二指肠吻合术，患者术后第8天出院。内脏反位与其他先天性畸形有关，包括脾脏畸形、左位肝和心脏异常；它很少与十二指肠闭锁相关。已有文献描述了内脏反位情况下的十二指肠梗阻，包括因网膜、狭窄、十二指肠前门静脉和完全闭锁导致的梗阻。本文所报告的患者在十二指肠第二部有一个十二指肠网膜。在进行手术之前，确定是否存在相关的胃肠道和心脏异常非常重要。
