General Surgery, Riverside Methodist Hospital, Columbus, Ohio, USA.
General Surgery, Riverside Methodist Hospital, Columbus, Ohio, USA
BMJ Case Rep. 2023 Sep 4;16(9):e253848. doi: 10.1136/bcr-2022-253848.
Intestinal malrotation is characterised by positional and congenital fixation abnormalities resulting from a failure in embryonic development in the normal 270° rotation around the axis of the superior mesenteric artery. Intestinal malrotation is primarily thought to affect neonates with an incidence of 1 in 500, however, only 1 in 6000 live births are symptomatic, and these usually present within the first month of life in 40% of cases and within the first year in over 5% of cases as an obstructive pathology or volvulus. In adults, however, the incidence has been documented at 0.2%. These patients usually present with postprandial symptoms that are intermittent such as bilious emesis, abdominal pain and malabsorption. Rarely, adults with congenital malrotation may present with acute obstruction due to volvulus, however, less than 100 adult cases are described in the literature. A high index of suspicion is required to identify cases of malrotation in the adult patient which leads to delays in diagnosis and therefore increases in morbidity can be seen.
肠旋转不良的特征是位置和先天性固定异常，这是由于肠系膜上动脉正常 270°旋转过程中的胚胎发育失败引起的。肠旋转不良主要被认为影响新生儿，发病率为 1/500，但只有 1/6000 的活产儿出现症状，这些症状通常在 40%的病例中出现在生命的第一个月内，超过 5%的病例中出现在生命的第一年，表现为梗阻性病变或扭转。然而，在成年人中，发病率已记录在 0.2%。这些患者通常表现为餐后间歇性症状，如胆汁性呕吐、腹痛和吸收不良。罕见情况下，先天性旋转不良的成年人可能会因扭转而出现急性梗阻，但文献中仅描述了不到 100 例成人病例。需要高度怀疑成年人的旋转不良病例，这会导致诊断延迟，因此发病率增加。
