Kernbach-Wighton Gerhard, Amberg Rainer, Madeal Burkhard
Arch Kriminol. 2016 Sep;238(3-4):128-135.
This report deals with two deaths of children involving intestinal volvulus, i. e. a pathological knotting and twisting of the mesenterial root on the basis of congenital malrotation followed by obstruction and extensive ischaenia.
(1) A 10-year-old girl (premature, 25th week) with severe disability, amaurosis and epilepsy was admitted to hospital due to general agitation and a bloated abdomen without peristaltic sounds, but died some hours later. Autopsy revealed a volvulus of 2/3 of the small intestine based on congenital malrotation with additional clamping of the intestine underneath adhesions (previous appendectomy). The abdominal cavity showed beginning peritonitis as the cause of death. (2) A 2-month-old premature male baby (surviving twin, 29th week) with a persisting ductus arteriosus was hospitalised for four weeks after failed vascular surgery due to acute general deterioration. Radiological diagnostics using a contrast medium revealed a vascular anomaly (right-sided aortic arch). Around 10 hours later, the infant developed an acute abdomen with ileus symptoms. Emergency surgery showed infarction of the entire small intestine due to an anti-clockwise 180⁰-volvulus, with death occurring 24h later. Further examination showed a malrotation as anomaly. Apparently, the volvulus had been caused by extensive use of contrast medium resulting in increased intestinal mobility.
本报告涉及两例儿童因肠扭转死亡的病例，即先天性肠旋转不良基础上肠系膜根部的病理性打结和扭转，随后出现梗阻和广泛缺血。
（1）一名10岁女孩（早产，孕25周），重度残疾，失明且患有癫痫，因全身躁动和腹胀入院，无肠鸣音，数小时后死亡。尸检发现基于先天性肠旋转不良的小肠2/3肠扭转，且在粘连下方（既往阑尾切除术）肠管受压。腹腔显示早期腹膜炎为死因。（2）一名2个月大的早产男婴（存活双胞胎，孕29周），患有动脉导管未闭，因血管手术失败后急性全身状况恶化住院四周。使用造影剂的放射学诊断显示血管异常（右侧主动脉弓）。约10小时后，婴儿出现急腹症和肠梗阻症状。急诊手术显示由于逆时针180⁰肠扭转导致整个小肠梗死，24小时后死亡。进一步检查显示肠旋转不良为异常情况。显然，肠扭转是由于大量使用造影剂导致肠道活动增加所致。
