Eksarko Polikseni, Nazir Sharique, Kessler Edmund, LeBlanc Patrick, Zeidman Michael, Asarian Armand P, Xiao Philip, Pappas Peter J
The Brooklyn Hospital Center, Brooklyn, NY, USA
The Brooklyn Hospital Center, Brooklyn, NY, USA.
J Surg Case Rep. 2013 Dec 18;2013(12):rjt110. doi: 10.1093/jscr/rjt110.
Intestinal obstruction due to midgut malrotation in neonates is well known. The incidence of malrotation in newborns is around 1:500 and the symptomatic incidence is 1:6000 births. Duodenal web as a cause of intestinal obstruction is less common and is reported to be 1:10 000-1:40 000. Malrotation is known to be associated with other congenital obstructive anomalies including duodenal atresia, stenosis and duodenal web. But, intestinal obstruction due to malrotation associated with duodenal web has been reported only rarely with a few published cases in our literature review. We present a case of intestinal obstruction diagnosed in the prenatal period via sonogram. A plain X-ray of the abdomen after birth showed a distended duodenum with paucity of air distally suggesting duodenal obstruction. An exploratory laparotomy showed a duodenal web proximal to the sphincter of oddi. The patient also had an associated malrotation and underwent Ladd's procedure and appendectomy. The post-operative period was uneventful.
新生儿中肠旋转不良导致的肠梗阻是众所周知的。新生儿中旋转不良的发生率约为1:500，有症状的发生率为1:6000活产儿。十二指肠蹼作为肠梗阻的原因较少见，据报道为1:10000 - 1:40000。已知旋转不良与其他先天性梗阻性异常有关，包括十二指肠闭锁、狭窄和十二指肠蹼。但是，在我们的文献综述中，仅有少数已发表的病例报道了旋转不良合并十二指肠蹼导致的肠梗阻。我们报告一例产前通过超声诊断为肠梗阻的病例。出生后腹部平片显示十二指肠扩张，远端气体减少，提示十二指肠梗阻。剖腹探查显示在Oddi括约肌近端有一个十二指肠蹼。该患者还伴有旋转不良，并接受了Ladd手术和阑尾切除术。术后恢复顺利。
