Kadravello Aravinthan, Yee Jane Chuah Wai, Chandran Pradeep Chand
General Surgery Department, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.
General Surgery Department, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.
Int J Surg Case Rep. 2024 Nov;124:110353. doi: 10.1016/j.ijscr.2024.110353. Epub 2024 Sep 26.
INTRODUCTION & IMPORTANCE: Situs Inversus Abdominalis (SIA) & Paraduodenal Hernias (PDH) are extremely rare causes acute surgical emergencies among adults. We present a case of an adult patient with intestinal obstruction secondary to PDH through the fossa of Landzert with concurrent SIA.
A thirteen-year-old Southeast Asian female with situs inversus abdominalis due to Kartagener syndrome presented with bowel obstruction. The patient failed conservative management and required surgical intervention. A diagnostic laparoscopy was done followed by laparotomy. Intraoperatively, there was a paraduodenal mesentery defect at the duodenojejunal junction with internal herniation of the terminal ileum and caecum. Successful reduction of bowels and closure of the mesentery defect was done without any bowel resection.
Only three cases of bowel obstruction secondary to SIA have been documented in literature. This is the fourth and the only case to have concurrent paraduodenal hernia. Surgical repair of PDH is mandatory to avoid the increased risk of incarceration or strangulation however pre-operative diagnosis of PDH resembles a diagnostic challenge especially among patients with intestinal anomalies.
Intestinal malrotation is known to be the most common cause of intestinal obstruction in patients with intestinal anomalies. However, clinicians should maintain a high index of suspicion of intestinal herniation and adhesions as the cause of intestinal obstruction in such cases. Further imaging such as computed tomography (CT) scan and diagnostic laparoscopy may be beneficial provided patients have no overt signs of acute bowel ischaemia.
腹内脏器反位（SIA）和十二指肠旁疝（PDH）是成人急性外科急症极为罕见的病因。我们报告一例成年患者，因通过朗格特窝的十二指肠旁疝并发SIA而导致肠梗阻。
一名13岁东南亚女性因卡塔格内综合征患有腹内脏器反位，出现肠梗阻。患者保守治疗失败，需要手术干预。先进行了诊断性腹腔镜检查，随后进行剖腹手术。术中发现十二指肠空肠交界处存在十二指肠旁系膜缺损，回肠末端和盲肠发生内疝。成功还纳肠管并关闭系膜缺损，未进行任何肠切除。
文献中仅记载了3例由SIA继发肠梗阻的病例。这是第4例，也是唯一一例并发十二指肠旁疝的病例。必须对PDH进行手术修复，以避免嵌顿或绞窄风险增加，然而PDH的术前诊断颇具挑战性，尤其是在伴有肠道异常的患者中。
肠旋转不良是已知肠道异常患者肠梗阻最常见的病因。然而，临床医生在此类病例中应高度怀疑肠疝和粘连是肠梗阻的病因。如果患者没有明显的急性肠缺血迹象，进一步的影像学检查如计算机断层扫描（CT）和诊断性腹腔镜检查可能会有所帮助。
