Wang Fanke, Han Zhe, Dai Yongjun, Wang Yuanyuan, Li Zhongxin
Department of Gastrointestinal Surgery, The First Hospital of Hebei Medical University, No.89 Donggang Road, Shijiazhuang, 050030, People's Republic of China.
J Med Case Rep. 2025 Mar 27;19(1):140. doi: 10.1186/s13256-025-05187-1.
Intestinal volvulus arises from the twisting of an intestinal loop around a fixed axis. This condition is distinguished by both the obstruction and constriction of the intestinal lumen, as well as the entrapment of intestinal blood vessels. Consequently, the intestinal obstruction resulting from volvulus is often of the strangulating variety, which poses a risk for swift intestinal necrosis. Mesenteric tumors are a notable precipitant of volvulus. However, certain nontumor lesions originating from the mesentery can also lead to severe intestinal volvulus.
A 68-year-old Chinese female individual was hospitalized because of severe abdominal pain that occurred 6 h after engaging in physical labor. An abdominal computed tomography examination revealed volvulus of the mesenteric root and the presence of a mixed-density mass in the right mesentery, with the possibility of a neoplastic process not ruled out. Emergency surgical exploration confirmed that the small mesenteric tumor served as a pivot, with the mesenteric root twisted 1440°, leading to total necrosis of the small intestine. As a result, total small intestine resection and enterostomy were performed. Postoperative pathological examination of the mesenteric tumor revealed fat necrosis, excessive calcification, peripheral fibrous tissue hyperplasia, and chronic inflammatory cell infiltration, consistent with a diagnosis of sclerosing mesenteritis. The patient's life was saved through timely surgical intervention. However, owing to the development of short bowel syndrome, she will require long-term dependence on parenteral nutrition.
Intestinal volvulus due to sclerosing mesenteric inflammation is an exceedingly rare occurrence. Clinicians should maintain a high index of suspicion for this condition when encountering cases of intestinal volvulus attributed to mesenteric tumors. Prompt and decisive surgical intervention is crucial for saving lives and for preserving as much of the intestinal tract as possible.
肠扭转是指肠袢围绕一个固定轴发生扭转。这种情况的特点是肠腔梗阻和狭窄，以及肠血管受压。因此，由扭转引起的肠梗阻通常是绞窄性的，有迅速发生肠坏死的风险。肠系膜肿瘤是扭转的一个显著诱因。然而，某些起源于肠系膜的非肿瘤性病变也可导致严重的肠扭转。
一名68岁的中国女性因在体力劳动6小时后出现严重腹痛而住院。腹部计算机断层扫描检查显示肠系膜根部扭转，右肠系膜有一个混合密度肿块，不排除肿瘤性病变的可能性。急诊手术探查证实，小肠系膜肿瘤作为一个轴点，肠系膜根部扭转1440°，导致小肠完全坏死。因此，进行了全小肠切除和肠造口术。肠系膜肿瘤的术后病理检查显示脂肪坏死、钙化过度、外周纤维组织增生和慢性炎症细胞浸润，符合硬化性肠系膜炎症的诊断。通过及时的手术干预挽救了患者的生命。然而，由于短肠综合征的发展，她将需要长期依赖肠外营养。
硬化性肠系膜炎症引起的肠扭转极为罕见。临床医生在遇到归因于肠系膜肿瘤的肠扭转病例时，应高度怀疑这种情况。及时而果断的手术干预对于挽救生命和尽可能保留肠道至关重要。
