Duodenum inversum as a cause of bilious emesis in a teenager: A case report

Shachi Srivatsa , Qican Weng , Karen A. Diefenbach , Benedict C. Nwomeh
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Abstract

Introduction

Duodenum inversum is a rare congenital anatomical variant and presents a myriad of clinical challenges. This case presentation highlights a unique case of symptomatic duodenum inversum diagnosed in the second decade of life requiring operative intervention.

Case presentation

We present the case of a thirteen-year-old male who presented with one year of intermittent abdominal pain with associated bilious emesis. Diagnostic work-up included multiple abdominal ultrasounds and abdominal radiographs which only revealed constipation. Despite adequate bowel regimen, patient's symptoms persisted. Duodenum inversum was diagnosed on a fluoroscopic upper gastrointestinal study and the patient was subsequently taken to the operating room to evaluate for concurrent midgut volvulus and malrotation. A diagnostic laparoscopy revealed fibrotic adhesive bands contributing to partial duodenal obstruction. Surgical resection of these bands alleviated the obstruction and resolved the patient's symptoms with no recurrence noted on post-operative follow-up.

Conclusion

In cases of duodenum inversum, recognition through diagnostic tools like fluoroscopic upper gastrointestinal studies is critical. While initial medical management may suffice for mild cases, surgical intervention remains the cornerstone for severe cases, particularly when obstruction is evident, emphasizing the necessity of tailored approaches based on clinical severity.

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十二指肠逆位是一名青少年胆汁性呕吐的病因:病例报告
导言十二指肠倒置是一种罕见的先天性解剖变异,给临床带来了无数挑战。本病例重点介绍了一例独特的症状性十二指肠倒置病例,该病例在患者生命的第二个十年被诊断出,需要进行手术干预。病例介绍 我们介绍了一名 13 岁男性的病例,该患者出现间歇性腹痛一年,伴有胆汁性呕吐。诊断性检查包括多次腹部超声波检查和腹部 X 射线检查,但仅发现便秘。尽管采取了适当的排便疗法,但患者的症状依然存在。上消化道透视检查确诊为十二指肠嵌顿,随后患者被送入手术室,以评估是否同时存在中肠翻卷和旋转不良。诊断性腹腔镜检查发现,纤维粘连带导致部分十二指肠梗阻。结论在十二指肠倒置病例中,通过透视上消化道检查等诊断工具进行识别至关重要。对于轻度病例,最初的药物治疗可能就足够了,但对于重度病例,特别是阻塞明显的病例,手术干预仍然是治疗的基石,这就强调了根据临床严重程度采取针对性治疗方法的必要性。
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来源期刊
CiteScore
0.60
自引率
25.00%
发文量
348
审稿时长
15 days
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