Hakoda Hiroyuki, Mishima Hideyuki, Habu Takumi, Murai Shin, Maeno Ryohei, Yokomizo Yuriko, Inagaki Yuki, Maruyama Takehito, Matsui Yuichi, Sako Akihiro
Department of Surgery, Hitachi General Hospital, 2-1-1 Jonan-cho, Hitachi, Ibaraki, 317-0077, Japan.
Clin J Gastroenterol. 2018 Dec;11(6):476-480. doi: 10.1007/s12328-018-0878-9. Epub 2018 Jun 18.
While there have been numerous reports about colovesical fistulas and ruptured intestinal diverticula, there have been far fewer reports about vesicointestinal fistulas caused by Meckel's diverticula. Most Meckel's diverticula are asymptomatic. Furthermore, they seldom cause vesicointestinal fistulas, and the associated complications are non-specific. Thus, their preoperative diagnosis is difficult. We experienced a case in which a vesicointestinal fistula was caused by a Meckel's diverticulum and was treated with laparoscopic surgery. A 46-year-old male was referred to our hospital after exhibiting hematuria. Cystoscopy revealed a fistula between the small intestine and bladder. Contrast-enhanced computed tomography and magnetic resonance imaging showed a diverticulum in the ileum and a fistula between the ileum and bladder, which passed through the diverticulum. A Meckel's diverticulum was suspected. We conducted a laparoscopic operation. We dissected the Meckel's diverticulum with an automatic suturing device and removed it together with part of the ileum. The patient's postoperative course was good. We experienced a case in which a vesicointestinal fistula was caused by a Meckel's diverticulum and was successfully treated with laparoscopic surgery. In selected cases of Meckel's diverticulum, the dissection of the diverticulum with an automatic suturing device is appropriate.
虽然已有大量关于结肠膀胱瘘和肠憩室破裂的报道,但由梅克尔憩室引起的膀胱肠瘘的报道却少得多。大多数梅克尔憩室是无症状的。此外,它们很少引起膀胱肠瘘,且相关并发症不具有特异性。因此,其术前诊断困难。我们遇到一例由梅克尔憩室引起的膀胱肠瘘并接受腹腔镜手术治疗的病例。一名46岁男性在出现血尿后被转诊至我院。膀胱镜检查发现小肠与膀胱之间有瘘管。增强计算机断层扫描和磁共振成像显示回肠有一个憩室,回肠与膀胱之间有一个瘘管,该瘘管穿过憩室。怀疑为梅克尔憩室。我们进行了腹腔镜手术。我们用自动缝合装置分离梅克尔憩室,并将其与部分回肠一并切除。患者术后恢复良好。我们遇到一例由梅克尔憩室引起的膀胱肠瘘并成功接受腹腔镜手术治疗的病例。在梅克尔憩室的特定病例中,用自动缝合装置分离憩室是合适的。