Chumber Sunil, Pol Manjunath Maruti, Akhtar Jawed, Uniyal Madhur
Department of Surgery, All India Institute of Medical Sciences, New Delhi, India.
BMJ Case Rep. 2015 Aug 26;2015:bcr2015211205. doi: 10.1136/bcr-2015-211205.
A 22-year-old man experiencing infrequent episodes of abdominal pain, distension, non-bilious vomiting and constipation, was diagnosed with malrotation of the gut. He was treated conservatively over the past 10 years. He was referred to our hospital owing to recent aggravation of symptoms. He had no signs of peritonitis. On imaging, malrotation of the gut, with midgut volvolus and situs inversus totalis, was found. Diagnosis was confirmed during laparotomy. A large sac was present to the right of midline. Detorsion of the sac was performed and the sac was opened. The duodenum and caecum were found in the left upper abdomen adherent to the lateral abdominal wall. Adhesiolysis was performed and extrinsic compression at the duodenum relieved. The large bowel was placed on the right side and small bowel was placed on the left. Appendectomy and feeding jejunostomy were performed. Thorough analysis (clinicoradiological) is necessary before considering conservative management in patients known to harbour a congenital anomaly of the gut.
一名22岁男性，时有腹痛、腹胀、非胆汁性呕吐及便秘发作，被诊断为肠道旋转不良。在过去10年里他接受了保守治疗。因近期症状加重，他被转诊至我院。他没有腹膜炎体征。影像学检查发现肠道旋转不良，伴有中肠扭转及全内脏反位。剖腹手术时确诊。中线右侧有一个大囊袋。对囊袋进行了扭转复位并打开。发现十二指肠和盲肠位于左上腹并与侧腹壁粘连。进行了粘连松解，解除了十二指肠的外部压迫。大肠置于右侧，小肠置于左侧。实施了阑尾切除术和空肠造口术。对于已知患有先天性肠道异常的患者，在考虑保守治疗之前，进行全面分析（临床影像学）是必要的。
