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误诊为梅克尔憩室伴内疝酷似阑尾炎:一例报告。

Misdiagnosed Meckel's diverticulum with internal hernia mimicking appendicitis: A case report.

作者信息

Zhang Qi, Xu Xiu-Juan, Ma Jun, Zhang Ya-Ming

机构信息

Department of General Surgery, Anqing Municipal Hospital, Anqing 246000, Anhui Province, China.

Department of Critical Medicine, Anqing Municipal Hospital, Anqing 246000, Anhui Province, China.

出版信息

World J Clin Cases. 2024 Jul 16;12(20):4391-4396. doi: 10.12998/wjcc.v12.i20.4391.

DOI:10.12998/wjcc.v12.i20.4391
PMID:39015903
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11235555/
Abstract

BACKGROUND

Meckel's diverticulum is a common congenital anomaly of the gastrointestinal tract, with a higher incidence rate in children under 7 years old. The condition is characteristically asymptomatic but may become a clinical concern when complications such as intestinal obstruction, bleeding, perforation, or diverticulitis precipitate acute abdominal presentations.

CASE SUMMARY

This report describes the case of a middle-aged man initially suspected of having acute appendicitis, which rapidly progressed to acute peritonitis with concomitant intestinal obstruction observed during preoperative assessment. Surgical exploration confirmed the diagnosis of Meckel's diverticulum-induced internal hernia, accompanied by intestinal obstruction and necrosis. In addition, the hernial ring base exhibited entrapment resembling a surgical knot.

CONCLUSION

Meckel's diverticulum is a rare cause of small bowel obstruction in adults, and it should be considered in a differential diagnosis.

摘要

背景

梅克尔憩室是一种常见的胃肠道先天性异常,在7岁以下儿童中发病率较高。该病症通常无症状,但当出现肠梗阻、出血、穿孔或憩室炎等并发症引发急性腹部症状时,可能会引起临床关注。

病例摘要

本报告描述了一名中年男性的病例,该患者最初被怀疑患有急性阑尾炎,在术前评估中迅速发展为急性腹膜炎,并伴有肠梗阻。手术探查证实诊断为梅克尔憩室引起的内疝,伴有肠梗阻和坏死。此外,疝环底部出现类似手术结的卡压。

结论

梅克尔憩室是成人小肠梗阻的罕见原因,在鉴别诊断时应予以考虑。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fdda/11235555/77849615896d/WJCC-12-4391-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fdda/11235555/c5635c15648b/WJCC-12-4391-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fdda/11235555/dca32ab61b4a/WJCC-12-4391-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fdda/11235555/77849615896d/WJCC-12-4391-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fdda/11235555/c5635c15648b/WJCC-12-4391-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fdda/11235555/dca32ab61b4a/WJCC-12-4391-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fdda/11235555/77849615896d/WJCC-12-4391-g003.jpg

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本文引用的文献

1
Increased Attenuation of Intestinal Contents at CT Indicates Bowel Necrosis in Closed-Loop Small Bowel Obstruction.CT 示肠内容物衰减增加提示闭袢性小肠梗阻肠坏死。
Radiology. 2024 Feb;310(2):e231710. doi: 10.1148/radiol.231710.
2
Meckel's diverticulum mimicking acute appendicitis in children: a retrospective cohort study. Meckel's 憩室在儿童中表现为急性阑尾炎:一项回顾性队列研究。
BMC Surg. 2024 Jan 30;24(1):40. doi: 10.1186/s12893-024-02323-4.
3
Clinical characteristics and treatment outcomes of symptomatic Meckel diverticulum: a comparative study among children, adolescent, and adult patients.
有症状的梅克尔憩室的临床特征及治疗结果:儿童、青少年和成年患者的比较研究
Ann Surg Treat Res. 2023 Aug;105(2):107-113. doi: 10.4174/astr.2023.105.2.107. Epub 2023 Aug 1.
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Internal Hernia after Laparoscopic Roux-en-Y Gastric Bypass: Optimal CT Signs for Diagnosis and Clinical Decision Making.腹腔镜 Roux-en-Y 胃旁路术后内疝:诊断的最佳 CT 征象和临床决策。
Radiology. 2017 Mar;282(3):752-760. doi: 10.1148/radiol.2016160956. Epub 2016 Sep 30.
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Clinics in diagnostic imaging (162). Meckel's diverticulum.诊断成像临床(第162期)。梅克尔憩室。
Singapore Med J. 2015 Sep;56(9):523-6; quiz 527. doi: 10.11622/smedj.2015138.