Rodriguez Zorro Andres, Vivas Diaz Jairo Hernando
470864 Instituto Nacional de Medicina Legal y Ciencias Forenses, Colombia.
Med Sci Law. 2018 Apr;58(2):115-118. doi: 10.1177/0025802418756780. Epub 2018 Feb 12.
Acute appendicitis is one of the most common surgical emergencies in paediatrics. However, acute appendicitis in early infancy is an uncommon condition. Furthermore, strangulation of the small intestine through appendicular knotting is described as very unusual in the literature and is generally not well-diagnosed in the clinical context. This article reports the case of a 23-month-old girl who entered the emergency department with a three-day history of abdominal symptoms and who died in less than 24 hours without receiving surgical intervention. The case turned judicial at the request of the parents who claimed lack of clarity in the diagnosis. A medico-legal autopsy was ordered to clarify the cause and manner of death. The autopsy documented herniation, strangulation and torsion of a 70 cm segment of the jejunum/ileum through an appendicular knot caused by the attachment of the distal end of the inflamed appendage to the ileum. The case is relevant because it is the first case of death by appendicular knot and strangulation of small bowel in an infant reported in the literature. The importance of autopsy to clarify the clinical diagnosis is noted.
急性阑尾炎是儿科最常见的外科急症之一。然而，婴儿早期的急性阑尾炎并不常见。此外，文献中描述通过阑尾打结导致小肠绞窄的情况非常罕见，在临床环境中通常难以得到准确诊断。本文报告了一名23个月大的女孩，她因腹部症状持续三天而进入急诊科，未接受手术干预，在不到24小时内死亡。应声称诊断不明确的父母要求，该病例进入司法程序。下令进行法医尸检以明确死因和死亡方式。尸检记录了一段70厘米长的空肠/回肠通过阑尾打结造成的疝出、绞窄和扭转，阑尾发炎的远端附着于回肠导致了这一情况。该病例具有重要意义，因为它是文献中报道的首例婴儿因阑尾打结和小肠绞窄死亡的病例。文中指出了尸检对明确临床诊断的重要性。
