Bratu Matei R, Balmes Bogdan, Diaconescu Bogdan I, Beuran Mircea
Chirurgia (Bucur). 2018 Jul-Aug;113(4):571-575. doi: 10.21614/chirurgia.113.4.571.
Among intestinal obstruction, intussusception is one of the rare mechanical causes in the adult period. When it is met it present with abdominal pain, vomiting and other symptoms compatible with intestinal obstruction varying on the segments being involved. Compared to pediatric invagination which it is mostly idiopathic the adult form has an organic etiology causing a blurred symptomatology and needing advanced imaging diagnosis like computerized tomography. We present the case of a 70 year old woman with multiple Emergency Department presentations with abdominal pain and vomiting which received a clear diagnosis only the third time she came to hospital. Ultrasonography and plain abdominal x-ray were no specific and only the CT scan revealed the real cause of obstruction. Also conservative measures were useless the definitive treatment being surgery, the lesion necessitating enteral resection and end to end anastomosis. The pathology report revealed a benign tumor of proximal jejunum. In conclusion, adult intestinal invagination, although it is a rare condition, can present with symptomatology varying with segment of bowel involved into the intussusception. Unlike pediatric invagination, the adult one needs standard surgical revision unless there are certain contraindications.
在肠梗阻中,肠套叠是成人期罕见的机械性病因之一。当出现肠套叠时,患者会出现腹痛、呕吐以及其他与肠梗阻相符的症状,这些症状会因受累肠段的不同而有所变化。与大多为特发性的小儿肠套叠相比,成人肠套叠具有器质性病因,导致症状不明确,需要像计算机断层扫描这样的先进影像诊断。我们报告一例70岁女性病例,该患者多次因腹痛和呕吐到急诊科就诊,直到第三次入院才得到明确诊断。超声检查和平片腹部X线检查均无特异性,只有CT扫描揭示了梗阻的真正原因。此外,保守治疗无效,最终治疗方法是手术,病变需要进行肠切除和端端吻合术。病理报告显示为近端空肠良性肿瘤。总之,成人肠套叠虽然是一种罕见疾病,但症状会因套叠所累及的肠段不同而有所变化。与小儿肠套叠不同,除非有特定禁忌证,成人肠套叠需要进行标准的手术治疗。