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一例创伤性空肠修补术后出现肠套叠的病例报告。

Case report of an intussusception presenting after a trauma jejunorrhaphy.

作者信息

Lee Paul K, Masi Antonio, Warshowsky Ethan A, Roudnitsky Valery

机构信息

Kings County Hospital, 451Clarkson Avenue, Brooklyn, N.Y, 11203, USA.

Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, USA.

出版信息

Ann Med Surg (Lond). 2020 Aug 14;58:1-3. doi: 10.1016/j.amsu.2020.08.008. eCollection 2020 Oct.

Abstract

INTRODUCTION

Intussusception in pediatric cases are predominantly idiopathic, while intussusception in adult cases are predominantly associated with a lesion. The differential diagnosis for the lesion includes Meckel's diverticulum, lipoma, adenoma, and metastatic disease.

PRESENTATION OF CASE

We report a case of intussusception in which the lead point was the site of a jejunorrhaphy for a jejunal perforation secondary to blunt abdominal trauma. The intussusception presented as a postoperative bowel obstruction requiring a re-laparotomy and a segmental bowel resection. The postoperative course after the re-laparotomy was unremarkable.

DISCUSSION

Postoperative intussusception with a bowel anastomosis acting as the lead point is a rare but described complication of anastomotic procedures. Our report is the first in the trauma literature to describe an intussusception led by a jejunorrhaphy rather than a circumferential suture or stapled anastomosis. While rare, this complication is a critical constituent in the differential diagnosis of bowel obstruction after laparotomy for trauma. Currently, no standardized technique or prophylactic maneuver exists to prevent intussusception after an intestinal repair.

摘要

引言

小儿肠套叠主要为特发性,而成人肠套叠主要与病变相关。病变的鉴别诊断包括梅克尔憩室、脂肪瘤、腺瘤和转移性疾病。

病例介绍

我们报告一例肠套叠病例,其套叠起始点为因钝性腹部创伤导致空肠穿孔而行空肠缝合术的部位。该肠套叠表现为术后肠梗阻,需要再次剖腹手术及肠段切除。再次剖腹手术后的术后病程平稳。

讨论

以肠吻合口作为套叠起始点的术后肠套叠是吻合手术中一种罕见但已被描述的并发症。我们的报告是创伤文献中首例描述由空肠缝合术而非环形缝合或吻合器吻合导致的肠套叠。虽然罕见,但这种并发症是创伤剖腹手术后肠梗阻鉴别诊断的重要组成部分。目前,尚无标准化技术或预防性措施来预防肠道修复术后的肠套叠。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/36f9/7452111/53d929338a16/gr1.jpg

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