Erdem Karadeniz, Sabri Atamanalp Selçuk
Department of General Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey.
Case Rep Surg. 2017;2017:4809406. doi: 10.1155/2017/4809406. Epub 2017 Jul 31.
Intestinal malrotation occurs if midgut does not complete or partially completes its 270° counter-clockwise rotation around the superior mesenteric artery during embryologic life. In general, it frequently manifests with vomiting due to duodenal obstruction and volvulus in the initial months of life, and it is very rare to manifest in the adulthood. A 20-year-old male patient who had severe abdominal pain, nausea, vomiting, and distention for one day was evaluated at the emergency department. On abdominal tomography "swirling appearance of structures around the superior mesenteric artery" was reported. CT appearance was considered compatible with a rotational anomaly. Emergency surgery was planned for the patient. In laparotomy, it was observed that an approximately 100 cm long small intestine segment was rotated around a band (Ladd) and ischemia was developed in this segment due to rotation of its mesentery. The rotation of the small intestinal mesentery was corrected by opening the bands. After the warm application to the intestinal mesenteric ischemia for a while, the color and the peristalsis of the intestines became normal. The patient was discharged on postoperative day 2 with suggestions.
如果中肠在胚胎期没有完成或部分完成围绕肠系膜上动脉的270°逆时针旋转，就会发生肠旋转不良。一般来说，它在生命的最初几个月常因十二指肠梗阻和肠扭转而表现为呕吐，在成年期表现极为罕见。一名20岁男性患者因严重腹痛、恶心、呕吐和腹胀1天在急诊科接受评估。腹部断层扫描报告显示“肠系膜上动脉周围结构呈漩涡状”。CT表现被认为与旋转异常相符。计划对该患者进行急诊手术。在剖腹手术中，观察到一段约100厘米长的小肠段围绕一条束带（Ladd束带）旋转，由于其肠系膜旋转，该段小肠出现缺血。通过打开束带纠正小肠系膜的旋转。对肠缺血进行一段时间的温热处理后，肠管颜色和蠕动恢复正常。患者术后第2天出院并给出了建议。
