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酷似附件病变的巨大梅克尔憩室扭转

Giant Meckel's diverticulum torsion that mimics adnexal pathology.

作者信息

Kirmizi Serdar, Kirmizi Demet Aydogan, Karagul Reyhan, Tolan Kerem

机构信息

Department of Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey.

Department of Obstetrics and Gynaecology, Malatya State Hospital, Malatya, Turkey.

出版信息

Int J Surg Case Rep. 2016;24:139-41. doi: 10.1016/j.ijscr.2016.05.033. Epub 2016 May 24.

Abstract

Meckel's diverticulum is a real diverticulum located at the antimesenteric portion of intestinal loops and including all layers of the intestinal wall. It is the most common congenital anomaly of the gastrointestinal tract, and its incidence is 1-3%. Many asymptomatic cases are diagnosed when complications occur. A 23-year-old female patient applied to gynaecology emergency clinic with pelvic pain complaint. Laparotomy was performed with the diagnosis of acute abdomen because the physical examination and imaging studies did not exclude tuboovary pathology. Giant Meckel's diverticulitis and ischemic bowel loops that had been torsion were observed. Obstruction is the most common complication and generally originates from inflammation, adhesions, intussusception and omphalo-mesenteric band. In this case, it was seen that mobilized diverticulitis can be complicated without any fibrous band or adhesion to adjacent organs. This case supports that there can be torsion of bowel in free Meckel's diverticulum. Meckel's diverticulum settled in the pelvic region can make a clinical manifestation that is difficult to distinguish from adnexal diseases. It should be kept in mind for cases that start with pelvic pain, form adnexal pathology suspicion and cause an acute abdomen.

摘要

梅克尔憩室是位于肠袢肠系膜对侧部分的真性憩室,包含肠壁各层。它是胃肠道最常见的先天性异常,发病率为1% - 3%。许多无症状病例在出现并发症时才被诊断出来。一名23岁女性患者因盆腔疼痛主诉前往妇科急诊就诊。由于体格检查和影像学检查未排除输卵管卵巢病变,故以急腹症诊断行剖腹手术。术中观察到巨大梅克尔憩室炎和扭转的缺血性肠袢。梗阻是最常见的并发症,通常源于炎症、粘连、肠套叠和脐肠系膜带。在本病例中,可见游离的憩室炎可在无任何纤维带或与相邻器官粘连的情况下发生并发症。该病例支持游离的梅克尔憩室内肠管可发生扭转。位于盆腔区域的梅克尔憩室可产生难以与附件疾病相鉴别的临床表现。对于以盆腔疼痛起病、形成附件病变怀疑并导致急腹症的病例应予以考虑。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/39ab/4898912/e919704177e6/gr1.jpg

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