Kageyama Yumiko, Yamaguchi Ryuzo, Watanabe Shinya, Aizu Keiji, Kobayashi Shinichiro, Sato Fumiya, Fujieda Hironori, Toyoda Yoshitaka, Iwata Tsutomu
Department of Surgery, Kasugai Municipal Hospital, 1-1-1 Takaki-cho, Kasugai-shi, Aichi, Japan.
Surg Case Rep. 2020 Sep 25;6(1):223. doi: 10.1186/s40792-020-00991-x.
Malrotation is a congenital anomaly during the development of the embryonic intestine. Although it is generally considered a pediatric surgical condition, it can have significant implications for adult surgery in terms of reconstruction.
The patient was an 85-year-old man with pancreatic cancer and intestinal malrotation. He underwent pancreaticoduodenectomy with modified Child's reconstruction. Because the ascending colon and efferent loop twisted easily, we fixed the ascending colon to the abdominal wall. Thereafter, right twist and stenosis of the efferent loop occurred. On the 22nd day after the initial surgery, detorsion and Braun anastomosis were performed for efferent loop fixation. Postoperative oral intake was good, and the patient was discharged from our hospital on the 24th day after the reoperation.
This is a rare case of pancreaticoduodenectomy with malrotation following reoperation due to a complication after Child's reconstruction. In similar cases of intestinal malrotation, it is important to consider avoiding coaxial positioning of intestinal parts and an upper abdominal space while selecting a reconstruction method.
肠旋转不良是胚胎肠道发育过程中的一种先天性异常。尽管它通常被认为是一种小儿外科疾病，但就重建而言，它对成人手术也可能有重大影响。
该患者为一名85岁男性，患有胰腺癌和肠旋转不良。他接受了改良Child法重建的胰十二指肠切除术。由于升结肠和输出袢容易扭转，我们将升结肠固定于腹壁。此后，输出袢发生右旋和狭窄。在初次手术后第22天，对输出袢进行了扭转复位和布朗吻合术以固定。术后经口进食良好，患者在再次手术后第24天从我院出院。
这是一例罕见的因Child法重建后出现并发症而再次手术的伴有肠旋转不良的胰十二指肠切除术病例。在类似的肠旋转不良病例中，选择重建方法时，考虑避免肠管部分同轴定位和上腹部空间很重要。
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