Ikeshima Yukari, Hisano Katsuya, Morisawa Takeshi, Inoue Kozue, Shimamoto Masahiro, Koujitani Toshiaki, Yonetani Masahiko, Yasufuku Masao
Rinsho Byori. 2014 Mar;62(3):231-4.
Midgut volvulus accompanied by intestinal malrotation is classified as a surgical emergency disease of the newborn, which emerges with the bilious vomiting or melena. This report presents four patients of this disease in our hospital, evaluated by color Doppler ultrasonography before surgical operation. All four patients were presented by bilious vomiting at the onset. By color Doppler ultrasonography method, the whirlpool sign which is the view of intestine and superior mesenteric vein rotated around with the axis of superior mesenteric artery, were shown in all cases. This whirlpool sign led to the diagnosis of midgut volvulus accompanied by intestinal malrotation. Intestinal contrast imaging was tested in three patients for the purpose of confirming the diagnosis. Repair of the volvulus and a ladd operation was performed in all four patients, without the excision of intestine because of no intestinal ischemic change. The clinical courses of four cases were good, and all patients were discharged within 17 days. Early diagnosis and timely surgical operation are essential for decreasing the possibility of occurring intestinal ischemic changes and improving clinical outcome after surgical operation. We propose that color Doppler ultrasonography is the powerful tool for the diagnosis of this disease, especially for the newborn, for whom the available diagnostic tests are limited.
伴有肠旋转不良的中肠扭转被归类为新生儿外科急症疾病,其表现为胆汁性呕吐或黑便。本报告介绍了我院收治的4例该疾病患者,术前均接受了彩色多普勒超声检查。所有4例患者发病初期均表现为胆汁性呕吐。通过彩色多普勒超声检查,所有病例均显示出肠管及肠系膜上静脉围绕肠系膜上动脉轴心旋转的漩涡征。该漩涡征提示伴有肠旋转不良的中肠扭转诊断。为明确诊断,对3例患者进行了肠道造影检查。所有4例患者均行扭转复位及Ladd手术,因无肠缺血改变未行肠切除。4例患者临床过程良好,均在17天内出院。早期诊断和及时手术对于降低肠缺血改变的发生可能性及改善术后临床结局至关重要。我们认为彩色多普勒超声是诊断该疾病的有力工具,尤其对于可采用的诊断检查有限的新生儿。