Bhandari Tika Ram, Shahi Sudha, Gautam Manish, Pandey Sanjay
Department of General Surgery, Universal College of Medical Sciences, Bhairahawa 32900, Nepal.
Department of ENT, National Academy of Medical Sciences, Kathmandu 44600, Nepal.
Int J Surg Case Rep. 2017;39:231-234. doi: 10.1016/j.ijscr.2017.08.037. Epub 2017 Aug 24.
Patent vitellointestinal duct occurs in about 2% of the population which unusually leads to small intestinal obstruction associated with high morbidity and mortality. Here we are reporting an unusual case of patent vitellointestinal duct causing small intestinal obstruction in an adult patient.
A 22-year-old male without any medical illness presented as an emergency with a 3day hystory of abdominal pain, multiple episode of vomiting and abdominal distention. Distended abdomen and sign of peritonitis were found on abdominal examination. Abdominal X-rays revealed multiple small intestinal air-fluid levels. A patent vitellointestinal duct extending from distal ileum to the posterior wall of the umbilicus was found causing closed loop ileal obstruction during laparotomy. Resection of a vitellointestinal duct along with gangrenous distal ileum and cecum with ileocolostomy was performed. He was discharged on the 8 th postoperative day.
Diagnosing and management of cause of intestinal obstruction in patients without history of abdominal surgery is very challenging. Early resuscitation and timely surgical intervention of intestinal obstruction due to a rare patent vitellointestinal duct can be life-saving measure.
The patent vitellointestinal duct is an uncommon entity in adults and moreover this disorder leading to intestinal obstruction is very rare. Surgeons should be aware of this infrequent cause of small bowel obstruction to allow for early diagnosis and to facilitate better patient outcomes.
卵黄管未闭在约2%的人群中出现,通常会导致小肠梗阻,发病率和死亡率较高。在此,我们报告一例卵黄管未闭导致成年患者小肠梗阻的罕见病例。
一名22岁无任何病史的男性因腹痛3天、多次呕吐及腹胀急诊入院。腹部检查发现腹部膨隆及腹膜炎体征。腹部X线显示多个小肠气液平面。剖腹手术时发现一条从回肠末端延伸至脐后壁的未闭卵黄管导致闭袢性回肠梗阻。切除卵黄管及坏死的回肠末端和盲肠并行回结肠造口术。患者术后第8天出院。
对于无腹部手术史的肠梗阻患者,病因的诊断和处理极具挑战性。对于因罕见的未闭卵黄管导致的肠梗阻,早期复苏和及时的手术干预可能是挽救生命的措施。
卵黄管未闭在成年人中并不常见,而且这种导致肠梗阻的疾病非常罕见。外科医生应了解这种小肠梗阻的罕见病因,以便早期诊断并改善患者预后。