Gürleyik E, Gürleyik G
Department of Surgery, Haydarpaşa Numune Hospital, Istanbul, Turkey.
Eur J Surg. 1998 Jan;164(1):51-5. doi: 10.1080/110241598750004959.
To find out the incidence and causes of small bowel volvulus in our region, and to analyse the results of our management.
Retrospective study.
Teaching hospital, Turkey.
38 Patients who had had no previous abdominal operations who were operated on for mechanical intestinal obstruction caused by small bowel volvulus.
Incidence of small bowel volvulus, details of patients, treatments, complications, and outcome.
Small bowel volvulus constituted 8%(38/466) of all cases of mechanical intestinal obstruction and 13%(38/292) of small bowel obstruction. Volvulus was primary in 18 (47%), and secondary in 20 (53%) patients. 33 Patients (87%) were male. The mean age of the whole group was 30 years, 42 and 19 in patients with primary and secondary volvulus, respectively (p=0.0005). The incidence of small bowel volvulus was 19%(27/143) in patients under 40 years, and 7%(11/149) in those over 40 years of age (p=0.005). Sixty percent of patients with secondary volvulus (12/20) were under 20 years of age compared with 17% of those with primary volvulus (3/18; p=0.009). The causes of secondary volvulus were Meckel's diverticulum in 14 patients (70%), and malrotation and ileosigmoid knotting in 3 patients each (15%). Segments of bowel were gangrenous in 12 patients (32%). Treatment was by simple untwisting in patients with viable segments of gut, or with resection of gangrenous segments and primary small bowel anastomosis. One patient died postoperatively of septic shock.
Small bowel volvulus is a common form of intestinal obstruction in our region. It carries a high risk of gangrene of twisted segments of bowel. Fortunately perforation of small bowel is uncommon, and resection and primary anastomosis is a safe procedure in cases of necrosis. Today the outcome of such patients is satisfactory. Early and proper management is essential for a good outcome.
了解本地区小肠扭转的发病率及病因，并分析我们的治疗结果。
回顾性研究。
土耳其的教学医院。
38例既往无腹部手术史、因小肠扭转导致机械性肠梗阻而接受手术治疗的患者。
小肠扭转的发病率、患者详细情况、治疗方法、并发症及治疗结果。
小肠扭转占所有机械性肠梗阻病例的8%（38/466），占小肠梗阻病例的13%（38/292）。18例（47%）患者为原发性扭转，20例（53%）为继发性扭转。33例（87%）患者为男性。全组患者的平均年龄为30岁，原发性扭转患者为42岁，继发性扭转患者为19岁（p = 0.0005）。40岁以下患者小肠扭转的发病率为19%（27/143），40岁以上患者为7%（11/149）（p = 0.005）。继发性扭转患者中60%（12/20）年龄在20岁以下，而原发性扭转患者中这一比例为17%（3/18；p = 0.009）。继发性扭转的病因中，梅克尔憩室14例（70%），肠旋转不良和回乙状结肠扭结各3例（15%）。12例（32%）患者肠段发生坏疽。对于肠段存活的患者，治疗方法为简单的扭转复位；对于肠段坏疽的患者，则行坏疽肠段切除及小肠一期吻合术。1例患者术后死于感染性休克。
小肠扭转是本地区肠梗阻的常见形式。扭转肠段发生坏疽的风险很高。幸运的是，小肠穿孔并不常见，对于坏死病例，切除及一期吻合术是一种安全的手术方法。如今这类患者的治疗结果令人满意。早期且恰当的治疗对于取得良好疗效至关重要。
