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从肠扭转到短肠综合征:广泛坏疽的影响。

From Volvulus to Short Bowel Syndrome: The Impact of Extensive Gangrene.

作者信息

Jaiswal Rechal, Jaiswal Shlok A, Husukale Himanshu D, Bendale Himali, Chavan Sharvi R

机构信息

General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.

General Surgery, Institute of Medical Sciences (IMS) and SUM Hospital, Bhubaneswar, IND.

出版信息

Cureus. 2024 Aug 13;16(8):e66817. doi: 10.7759/cureus.66817. eCollection 2024 Aug.

Abstract

Compound volvulus, also known as ileosigmoid knotting, is an unusual but dangerous surgical condition that causes intestinal obstruction. It is a rare condition when an area of the small intestines is twisted and interrupts the blood supply, a closed-loop obstruction that is not common for one of the causes of intestinal blockage. Still, it is essential to distinguish the difference between an ileosigmoid knot and a simple sigmoid volvulus from each other, which are managed differently. Unlike abdominal X-rays, which are often nothing but clear images, CT scans or MRIs in their place provide more precise diagnostic information to help this problem diagnosis be traced. The first step in treating the patient is to immediately do an emergency laparotomy if the case involves ileosigmoid knotting, and which specific surgical procedure to use-resectional or non-resectional-is determined by the surgeon during the operation, who is considering such scales as the extent of the affected vascular compromise, the presence of necrosis or perforation, and the overall viability of the involved intestinal loops to conduct the most sought-after therapy.  In this case, the 45-year-old male presented with insidious-onset abdominal pain, vomiting, and constipation, along with signs of dehydration and hypotension. Physical examination revealed a distended abdomen, absent bowel sounds, and elevated white blood count and lactate levels, with an erect abdominal X-ray showing a dilated bowel, suggesting acute bowel obstruction with possible ischemia. This clinical presentation is consistent with acute bowel obstruction, potentially due to ileosigmoid knotting, which requires urgent surgical intervention. Short bowel syndrome is a malabsorptive disorder characterized by the presence of less than 200 cm of the small bowel, sometimes as a result of congenital or surgical causes. This is a real problem for an individual because he or she must be cautious and watch what they eat and how much they eat fortified foodstuffs, as the decreased absorptive capability of the small intestine can restrict the body's ability to take in and make use of necessary nutrients, fluids, and electrolytes.

摘要

复合性肠扭转,也称为回肠乙状结肠扭结,是一种罕见但危险的外科病症,可导致肠梗阻。当小肠的某个区域发生扭转并中断血液供应时,这是一种罕见的情况,作为肠梗阻的原因之一,这种闭环性梗阻并不常见。不过,区分回肠乙状结肠扭结和单纯乙状结肠扭转之间的差异至关重要,因为它们的处理方式不同。与腹部X光片通常只能提供清晰图像不同,CT扫描或MRI能提供更精确的诊断信息,有助于追踪这个问题的诊断。治疗患者的第一步是,如果病例涉及回肠乙状结肠扭结,应立即进行急诊剖腹手术,具体使用哪种手术方式——切除性或非切除性——由外科医生在手术过程中根据诸如受影响的血管受损程度、坏死或穿孔的存在情况以及受累肠袢的整体活力等因素来决定,以进行最理想的治疗。在这个病例中,一名45岁男性出现隐匿性腹痛、呕吐和便秘,伴有脱水和低血压迹象。体格检查发现腹部膨隆、肠鸣音消失,白细胞计数和乳酸水平升高,立位腹部X光片显示肠管扩张,提示急性肠梗阻伴可能的缺血。这种临床表现与急性肠梗阻相符,可能是由于回肠乙状结肠扭结所致,需要紧急手术干预。短肠综合征是一种吸收不良性疾病,其特征是小肠长度不足200厘米,有时是先天性或手术原因导致的。这对个人来说是个实际问题,因为他或她必须小心并留意自己的饮食以及食用强化食品的量,因为小肠吸收能力下降会限制身体摄取和利用必需营养素、液体和电解质的能力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b9b1/11393147/efd0a4f1a4fd/cureus-0016-00000066817-i01.jpg

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