Pokharel Pashupati, K C Milan, Ghimire Sagun, Yadav Arjun, Bhusal Kabi Raj, Kansakar Prasan Bir Singh
Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
Department of General Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Int J Surg Case Rep. 2023 Apr;105:108052. doi: 10.1016/j.ijscr.2023.108052. Epub 2023 Mar 29.
Volvulus is the twisting of the mesentery of the bowel along its axis. Ileal volvulus is a rare cause of small bowel obstruction. Ileal volvulus coexisting with autosomal dominant polycystic kidney disease has not been reported in the literature previously.
65-year male with known history of autosomal dominant polycystic kidney disease (ADPKD) presented with pain abdomen for 5 days, obstipation for 3 days, and multiple episodes of bilious vomiting in the emergency department. Being a suspect of bowel obstruction, X-ray abdomen was done which showed features of small intestine obstruction. Further, to find the etiology of obstruction, contrast enhanced computed tomography (CECT) abdomen was done which showed swirling of the ileal loop and the ileal mesenteric vessels along with transition point in the ileal loop suggestive of ileal volvulus. Exploratory laparotomy with detorsion of the volvulus was done for management.
Small bowel volvulus, more specifically ileal volvulus, is a rare cause of intestinal obstruction. Patients present with the cardinal features of bowel obstruction, i.e., abdominal pain, distension, vomiting, and constipation/obstipation. Our patient had coexisting ADPKD which further aggravated the clinical presentation. Definitive management of the volvulus includes exploratory laparotomy and detorsion along with resection of the bowel if found ischemic. In our case the bowel was healthy so only detorsion was done.
Early diagnosis and meticulous exploratory laparotomy is utmost for the management of ileal volvulus. Besides, the secondary etiology (ADPKD in our case) should be managed to prevent future recurrences.
肠扭转是指肠系膜沿其轴发生扭转。回肠扭转是小肠梗阻的罕见原因。回肠扭转与常染色体显性多囊肾病并存的情况此前文献中未见报道。
一名65岁男性，有常染色体显性多囊肾病（ADPKD）病史，因腹痛5天、便秘3天，在急诊科多次发生胆汁性呕吐前来就诊。怀疑为肠梗阻，进行了腹部X线检查，显示有小肠梗阻特征。进一步为明确梗阻病因，进行了腹部增强CT（CECT）检查，显示回肠袢及回肠系膜血管呈漩涡状，回肠袢有移行点，提示回肠扭转。行剖腹探查术并对扭转进行复位处理。
小肠扭转，更具体地说是回肠扭转，是肠梗阻的罕见原因。患者表现出肠梗阻的主要特征，即腹痛、腹胀、呕吐和便秘/ 顽固便秘。我们这位患者同时患有ADPKD，这进一步加重了临床表现。扭转的确定性治疗包括剖腹探查、复位，如果发现肠管缺血则进行肠切除。在我们这个病例中，肠管是健康的，所以只进行了复位。
早期诊断和细致的剖腹探查术对回肠扭转的治疗至关重要。此外，应处理继发病因（我们病例中的ADPKD）以防止未来复发。
