Kareem Tayeb Sabir, Abdi Mahmoud Ali
Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq.
College of Medicine, University of Zakho, Zakho, Kurdistan Region, Iraq.
Int J Surg Case Rep. 2020;76:446-449. doi: 10.1016/j.ijscr.2020.10.024. Epub 2020 Oct 9.
Intussusception can occur anywhere in the small and large bowel, ileocolic intussusception is the most common type in adult and there are few reported cases of jejunojejunal intussusception. Here we report a case of jejunojejunal intussusception due to an iatrogenic lead point at the feeding jejunostomy closure site.
In 2019 we received a 63-year-old female complaining of abdominal pain, constipation, and repeated vomiting for five days. On physical examination, she was dehydrated, in pain, and had a nasogastric tube that was draining bilious fluid. The abdomen was tender, there was a long midline incision with tension sutures at the lower of incision. CT of the abdomen showed ileoileal intussusception. Proper resuscitation and preoperative preparation were done. During exploratory laparotomy, there was jejunojejunal intussusception. The intussusception was reduced gently and completely. Resection of the lead point segment done with end to end anastomosis. The patient recovered uneventfully and discharged home on the 5 postoperative day. The patient followed up after one and three months with no complications.
During the closure of the feeding jejunostomy site by hand-sewn technique, over invagination of the second (seromuscular) layer of the wall of the jejunum might become so thick at the site of the closure that it acts as a lead point for intussusception. We reported a case of such a scenario.
肠套叠可发生于小肠和大肠的任何部位，回结肠型肠套叠是成人中最常见的类型，空肠空肠型肠套叠的报道病例较少。在此，我们报告一例因喂养空肠造口关闭部位医源性引导点导致的空肠空肠型肠套叠病例。
2019年，我们接诊了一名63岁女性，她主诉腹痛、便秘及反复呕吐5天。体格检查发现她脱水、疼痛，有一根正在引出胆汁样液体的鼻胃管。腹部压痛，有一条长的中线切口，切口下端有张力缝线。腹部CT显示回肠回肠型肠套叠。进行了适当的复苏和术前准备。在剖腹探查术中，发现为空肠空肠型肠套叠。肠套叠被轻柔且完全复位。切除引导点肠段并进行端端吻合。患者恢复顺利，术后第5天出院。患者在术后1个月和3个月进行随访，无并发症发生。
在用手工缝合技术关闭喂养空肠造口部位时，空肠壁第二层（浆肌层）过度内翻可能在关闭部位变得过厚，从而成为肠套叠的引导点。我们报告了这样一例病例。
