Patel Ramnik V, Jackson Paul, Zani Augusto, De Coppi Paolo
Department of Paediatric Urology, University College London Hospitals NHS Foundation Trust, London, UK Department of Paediatric Urology, Great Ormond Street Children's Hospital NHS Trust, London, UK.
Department of Paediatric Surgery, GOSH and ICH, London, UK.
BMJ Case Rep. 2014 Jun 26;2014:bcr2013200714. doi: 10.1136/bcr-2013-200714.
An unusual case of miliary plastic peritonitis associated with midgut malrotation in an adolescent in whom various diagnostic investigations, medical management and staged initial laparoscopic diagnostic followed by therapeutic procedure was curative have been presented. Tuberculous miliary plastic peritonitis causes dense adhesions between bowel loops and prevents midgut volvulus in a pre-existing malrotation. Diagnosis can be a challenge and threshold for diagnostic laparoscopy should be low. Interval correction of malrotation by laparoscopy after complete resolution of tuberculosis is easy, safe and effective, and cosmetically more pleasing. Midgut malrotation is a congenital anomaly referring to either lack of or incomplete rotation of fetal axis around the axis of superior mesenteric artery during fetal development. Most patients present with bilious vomiting in the first month of life because of duodenal obstruction or a volvulus. This is an unusual case of midgut malrotation in association with tuberculous peritonitis in an adolescent boy.
本文介绍了一例青少年患者，其患有粟粒性增殖性腹膜炎并伴有中肠旋转不良，通过各种诊断性检查、药物治疗以及分阶段的初始腹腔镜诊断并随后进行治疗性手术，最终治愈。结核性粟粒性增殖性腹膜炎会导致肠袢之间形成致密粘连，并防止已有旋转不良的中肠发生扭转。诊断可能具有挑战性，腹腔镜诊断的阈值应较低。在结核病完全消退后，通过腹腔镜对旋转不良进行分期矫正简单、安全且有效，而且在美观上更令人满意。中肠旋转不良是一种先天性异常，指胎儿发育过程中围绕肠系膜上动脉轴的胎儿轴缺乏或未完全旋转。大多数患者在出生后的第一个月因十二指肠梗阻或扭转而出现胆汁性呕吐。这是一例青少年男性中肠旋转不良合并结核性腹膜炎的罕见病例。
