Kawai Hironari, Omura Nobuo, Hirabayashi Tsuyoshi, Shimada Tetsuya, Kawahara Hidejiro
Surgery, Nishisaitama-Chuo National Hospital, Tokorozawa, JPN.
Pathology, Nishisaitama-Chuo National Hospital, Tokorozawa, JPN.
Cureus. 2023 Dec 22;15(12):e50934. doi: 10.7759/cureus.50934. eCollection 2023 Dec.
Meckel's diverticulum (MD) is a commonly encountered congenital gastrointestinal abnormality. Although the frequency of MD-related complications such as inflammation or bleeding is relatively high, small bowel obstruction induced by axial torsion of the MD is rare. Therefore, we herein report such a case along with a review of the literature. A 34-year-old female with right lower quadrant pain, nausea, and vomiting was admitted to our hospital with the diagnosis of adhesive small bowel obstruction due to a cesarean section performed five years previously. A long intestinal tube was placed, and the patient's clinical symptoms and X-ray findings showed relief of the small bowel obstruction. However, she developed severe right lower quadrant pain after contrast examination through the long intestinal tube despite the fact that the contrast agent had smoothly reached the terminal ileum. Blood tests and enhanced computed tomography (CT) showed a remarkable elevation of inflammatory markers, the appearance of ascites, and closed-loop-like and abscess-like appearances near the site of the caliber change. With a diagnosis of internal hernia, the patient underwent emergency laparotomy by means of a midline incision. Purulent ascites was observed within the abdominal cavity. Small bowel obstruction caused by a single band was observed in the right lower quadrant. Further exploration revealed an inflammatory MD with neck torsion and a mesodiverticular band (MDB). Simple mesodiverticular band resection by electrocautery and diverticulectomy by linear stapler were performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 7. In the case of juvenile-onset small bowel obstruction, axial torsion of the MD should be considered as a differential diagnosis. Herein, we report such a difficult diagnostic case and the first English literature review of small bowel obstruction due to axial torsion of the MD.
梅克尔憩室（MD）是一种常见的先天性胃肠道异常。尽管MD相关并发症如炎症或出血的发生率相对较高，但MD轴向扭转引起的小肠梗阻却很罕见。因此，我们在此报告这样一例病例并进行文献复习。一名34岁女性，因右下象限疼痛、恶心和呕吐入院，诊断为粘连性小肠梗阻，病因是5年前进行的剖宫产手术。放置了一根长肠管，患者的临床症状和X线检查结果显示小肠梗阻有所缓解。然而，尽管造影剂顺利到达回肠末端，但在通过长肠管进行造影检查后，她出现了严重的右下象限疼痛。血液检查和增强计算机断层扫描（CT）显示炎症标志物显著升高、出现腹水，且在管径变化部位附近呈现闭环样和脓肿样表现。诊断为内疝后，患者通过中线切口接受了急诊剖腹手术。腹腔内可见脓性腹水。右下象限观察到由单一束带引起的小肠梗阻。进一步探查发现一个炎症性MD伴颈部扭转和憩室系膜带（MDB）。通过电灼术进行简单的憩室系膜带切除术，并使用线性吻合器进行憩室切除术。术后病程顺利，患者于术后第7天出院。对于青少年起病的小肠梗阻，应考虑MD轴向扭转作为鉴别诊断。在此，我们报告这样一例诊断困难的病例以及关于MD轴向扭转导致小肠梗阻的首篇英文文献复习。
