Sigler Gregory, Baker Laura, Tadros Shaheer, Rekman Janelle, Apte Sameer S
Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
J Surg Case Rep. 2020 Nov 12;2020(11):rjaa449. doi: 10.1093/jscr/rjaa449. eCollection 2020 Nov.
A 79-year-old male presented with abdominal pain, incidental umbilical hernia and acute midgut volvulus that was not detected until surgical exploration. When he presented to hospital, computed tomography (CT) findings indicated perforated jejunoileal diverticulitis; however, in the operating room clockwise volvulization of the jejunum and ileum, secondarily inflamed jejunoileal diverticula, incomplete malrotation (right-sided duodenojejunal flexure), right retroperitoneal adhesions (Ladd's bands) and numerous other congenital adhesive bands were found. A modified Ladd's procedure and umbilical hernia repair were completed including detorsion, division of Ladd's bands with medialization of the cecum and lysis of other congenital adhesions without appendectomy. The patient recovered to baseline function by 3 weeks postoperatively. Acute midgut volvulus is a life-threatening surgical emergency that is exceptionally rare in the elderly. CT is relatively insensitive, so misdiagnosis is common. A high index of suspicion is required, especially in patients with a history of congenital gastrointestinal abnormalities. Prompt surgical exploration for correction and prevention is crucial.
一名79岁男性因腹痛、偶然发现的脐疝和急性中肠扭转入院，直到手术探查才被发现。他入院时，计算机断层扫描（CT）结果显示空肠回肠憩室炎穿孔；然而，在手术室中发现空肠和回肠顺时针扭转、继发性炎症性空肠回肠憩室、不完全旋转不良（右侧十二指肠空肠曲）、右腹膜后粘连（Ladd束）以及许多其他先天性粘连带。完成了改良的Ladd手术和脐疝修补术，包括扭转复位、切断Ladd束并将盲肠内移以及松解其他先天性粘连，未进行阑尾切除术。患者术后3周恢复至基线功能。急性中肠扭转是一种危及生命的外科急症，在老年人中极为罕见。CT相对不敏感，因此误诊很常见。需要高度怀疑，尤其是有先天性胃肠道异常病史的患者。及时进行手术探查以纠正和预防至关重要。
