Norris Joseph Michael, Owusu Desmond, Abdullah Ammar Adel, Rajaratnam Kanapathippillai
Department of Surgery, University of Cambridge Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK.
Department of Accident & Emergency, Basildon University Hospital, London, Essex, UK.
BMJ Case Rep. 2014 Oct 29;2014:bcr2014207163. doi: 10.1136/bcr-2014-207163.
Intestinal malrotation is an abnormality that usually presents in infanthood. Following correction, complications are rare in adults. We describe a case of a 64-year-old woman with a history of malrotation who presented with anaemia and weight loss. Colonic cancer was apparently excluded by colonoscopy. In fact, endoscopy had only been performed up to the hepatic flexure, which was unexpectedly positioned in the right iliac fossa. The patient then underwent a CT pneumocolon study, which demonstrated a caecal tumour, unusually located subhepatically. Repeat colonoscopy was performed to the true caecum and the lesion was biopsied. The patient underwent uncomplicated open right hemicolectomy and made a full recovery. To avoid diagnostic delay and, at worst, missing pathology entirely, clinicians must always thoroughly review a patient's history. Adults with malrotation may have atypical presentations of abdominal disease and so it is pertinent that surgeons, endoscopists and general practitioners remain alert and cognisant of their patients' history.
肠旋转不良是一种通常在婴儿期出现的异常情况。矫正后，成人很少出现并发症。我们描述了一例64岁有旋转不良病史的女性，她出现贫血和体重减轻。结肠镜检查显然排除了结肠癌。事实上，内镜检查仅进行到肝曲，而肝曲意外地位于右髂窝。患者随后接受了CT结肠气钡造影检查，显示盲肠肿瘤，异常位于肝下。对真正的盲肠进行了重复结肠镜检查并对病变进行了活检。患者接受了无并发症的开放性右半结肠切除术并完全康复。为避免诊断延误，以及在最坏的情况下完全漏诊病理，临床医生必须始终全面回顾患者的病史。患有旋转不良的成年人可能有腹部疾病的非典型表现，因此外科医生、内镜医生和全科医生必须保持警惕并了解患者的病史。
