Song Jianning, Ge Zhicheng, Liu Yuan, Yin Jie, Yao Hongwei, Zhang Zhongtao
Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, PR China.
Medicine (Baltimore). 2019 Jul;98(29):e16365. doi: 10.1097/MD.0000000000016365.
Complete small intestinal volvulus is a rare entity in adults, unlike partial intestinal volvulus. Although prompt surgical intervention is the mainstay of treatment, attention should also be paid to recovery of intestinal function postoperatively. Ignoring this issue during the postoperative recovery process can have serious consequences. We report the case of an 82-year-old woman with complete small intestinal volvulus at the root of the superior mesenteric vessel.
The patient was admitted for acute onset (22 hours) of abdominal pain and distention. Nausea and vomiting also developed during this period.
Abdominal physical examination was suspicious for peritoneal irritation. Computed tomography scan showed anticlockwise swirl of the mesenteric vessels at the lower margin of the pancreas with distension of the entire small intestine. A complete small intestinal volvulus was diagnosed.
Laparotomy and detorsion of the volvulus were performed after early diagnosis.
The patient developed intestinal wall edema because of ischemic-reperfusion damage. She exhibited severe abdominal distention and absent intestinal motility. Two days later, she went into septic shock; she died 19 days after surgical intervention.
Because complete small intestinal volvulus involves the entire intestine, ischemic-reperfusion intestinal damage after detorsion may be severe and can predict prognosis.
与部分肠扭转不同，完全性小肠扭转在成人中是一种罕见的情况。尽管及时的手术干预是主要的治疗方法，但术后肠道功能的恢复也应受到关注。在术后恢复过程中忽视这个问题可能会产生严重后果。我们报告一例82岁女性患者，其肠系膜血管根部发生完全性小肠扭转。
患者因突发（22小时）腹痛和腹胀入院。在此期间还出现了恶心和呕吐。
腹部体格检查怀疑有腹膜刺激征。计算机断层扫描显示胰腺下缘肠系膜血管逆时针旋转，整个小肠扩张。诊断为完全性小肠扭转。
早期诊断后进行了剖腹手术和扭转复位。
患者因缺血再灌注损伤出现肠壁水肿。她表现出严重的腹胀和肠麻痹。两天后，她发生感染性休克；手术干预19天后死亡。
由于完全性小肠扭转累及整个肠道，扭转复位后缺血再灌注性肠损伤可能很严重，且可预测预后。
