Seth Ajai, Seth Jai
Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PX, UK.
J Med Case Rep. 2011 Mar 28;5:118. doi: 10.1186/1752-1947-5-118.
In 1809, Johann Friedrich Meckel described the embryology of a small bowel diverticulum, which now bears his name. Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, with a prevalence ranging from 1% to 4% of the population. The majority are clinically silent and are incidentally identified at surgery or at autopsy. The lifetime risk of complications is estimated at 4%, with most of these complications occurring in adults. It is these cases that can cause problems for the clinician, as the diagnosis can be elusive and the consequences extremely serious.
We present the case of a 68-year-old Caucasian man with axial torsion of a Meckel's diverticulum around its base, a rare complication. He presented with acute, severe abdominal pain, and a clinical diagnosis of perforated acute appendicitis was made. Laparotomy revealed a torted Meckel's diverticulum with distal necrosis and perforation, which was resected. His recovery was uncomplicated, and he was discharged to home six days post-operatively.
Torsion is an extremely rare complication of Meckel's diverticulum. Its presentation can be elusive, and it can mimic a number of different, more common intra-abdominal pathologies. Imaging appears to be an unreliable diagnostic tool, and the diagnosis is usually made intra-operatively. Factors pre-disposing these patients to axial torsion of Meckel's diverticulum include the presence of mesodiverticular bands, a narrow base, excessive length, and associated neoplastic growth or inflammation of the diverticulum. The importance of searching for a diseased Meckel's diverticulum at laparotomy in appropriate circumstances is highlighted. Once identified, prompt surgical excision generally leads to an uncomplicated recovery.
1809年，约翰·弗里德里希·梅克尔描述了小肠憩室的胚胎学，现在该憩室以他的名字命名。梅克尔憩室是胃肠道最常见的先天性异常，在人群中的患病率为1%至4%。大多数在临床上无症状，是在手术或尸检时偶然发现的。并发症的终生风险估计为4%，其中大多数并发症发生在成年人中。正是这些病例会给临床医生带来问题，因为诊断可能难以捉摸，后果极其严重。
我们报告一例68岁的白种男性，其梅克尔憩室围绕其基部发生轴向扭转，这是一种罕见的并发症。他表现为急性、严重的腹痛，临床诊断为急性阑尾炎穿孔。剖腹手术发现一个扭转的梅克尔憩室，伴有远端坏死和穿孔，予以切除。他恢复顺利，术后六天出院。
扭转是梅克尔憩室极其罕见的并发症。其表现可能难以捉摸，可模仿多种不同的、更常见的腹腔内病变。影像学似乎是一种不可靠的诊断工具，诊断通常在手术中做出。使这些患者易发生梅克尔憩室轴向扭转的因素包括存在憩室系膜带、基部狭窄、长度过长以及憩室相关的肿瘤生长或炎症。强调了在适当情况下剖腹手术时寻找患病梅克尔憩室的重要性。一旦发现，及时手术切除通常会导致顺利康复。
