Patel Ramnik V, Khoo A Kate, De Coppi Paolo, Pierro Agostino
Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, London, UK.
BMJ Case Rep. 2013 Jul 8;2013:bcr2013200283. doi: 10.1136/bcr-2013-200283.
We describe an unusual case of ileal atresia, resulting from antenatal strangulation of a Meckel's diverticulum in an exomphalos minor. This is a rare antenatal complication of Littre's hernia, which has not been previously described. A small exomphalos minor at the base of umbilical cord and late onset vascular accident at the narrow defect leading to ileal atresia may be missed in the prenatal diagnosis. The triad of exomphalos minor, Meckel's diverticulum and terminal ileal atresia secondary to antenatal strangulation of Littre's hernia is very rare to find in the same patient. A small exomphalos minor at the base of the umbilical cord can be missed even in the postnatal period. Our case lends direct evidence of vascular accident as a cause of ileal atresia and supports vascular theory. Whenever possible umbilicus should be preserved naturally and exomphalos sac should be opened higher up for excellent cosmetic results.
我们描述了一例罕见的回肠闭锁病例，其病因是脐膨出较小的胎儿期美克尔憩室发生绞窄。这是利特尔疝罕见的产前并发症，此前尚未见相关描述。脐带根部的小脐膨出以及狭窄缺损处的迟发性血管意外导致回肠闭锁，可能在产前诊断中被漏诊。脐膨出较小、美克尔憩室以及利特尔疝产前绞窄继发的末端回肠闭锁这三者同时出现在同一患者身上的情况极为罕见。即使在出生后，脐带根部的小脐膨出也可能被漏诊。我们的病例为血管意外作为回肠闭锁的病因提供了直接证据，并支持血管学说。只要有可能，应尽量自然保留脐部，脐膨出囊应在较高位置打开，以获得良好的美容效果。
