Trans-anal prolapse of intussuscepted ileal Hartmann's pouch: A case report

Yu Liu, Youcheng Zhang, Ting Wang
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Abstract

Introduction

Postoperative complications of stomas in necrotizing enterocolitis (NEC) typically affect the proximal limb. Complications of the distal limb are rarely reported.

Case presentation

A 17-day-old newborn underwent an end ileostomy and an ileal Hartmann's pouch due to necrotizing enterocolitis (NEC). Eight weeks after the surgery, he passed bloody stool through the anus. No drop in his hemoglobin level was observed. He was made NPO, and no further bloody stool was seen after 24 hours. Ten weeks post-surgery he developed acute vomiting, and a 10-cm segment of bowel was seen prolapsed through the anus. The end of the prolapsed bowel was blind, raising the suspicion of a complete prolapse of the ileal Hartmann's pouch. He was taken to the operating room for an exploratory laparotomy. We found that the ileal Hartmann's pouch had intussuscepted into the ileocecal valve, progressed through the colon and the rectum, and prolapsed through the anus. We reduced the bowel manually. The involved ileum and colon were markedly swollen, and partially necrotic. The necrotic segments were resected, and the ileostomy was reversed. The patient was discharged one month later and had no adverse complications at two months of follow up.

Conclusion

Although rare, intussusception of an ileal Hartmann's pouch should be ruled out in patients that have a Hartmann's pouch and develop vomiting and bloody stool.
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经肛门的回肠哈特曼袋脱垂:病例报告
导言:坏死性小肠结肠炎(NEC)造口术后并发症通常影响近端肢体。病例介绍 一名 17 天大的新生儿因坏死性小肠结肠炎(NEC)而接受了回肠造口术和回肠哈特曼袋。术后八周,他从肛门排出血便。他的血红蛋白水平没有下降。他接受了 NPO 治疗,24 小时后未再出现血便。手术后十周,他出现了急性呕吐,并看到一段 10 厘米长的肠子从肛门脱出。脱垂肠管的末端是盲肠,因此怀疑回肠哈特曼氏囊完全脱垂。他被送往手术室进行探查性开腹手术。我们发现,回肠哈特曼氏囊已侵入回盲瓣,穿过结肠和直肠,从肛门脱出。我们手动缩小了肠道。受累的回肠和结肠明显肿胀,部分坏死。我们切除了坏死的肠段,并反转了回肠造口术。结论回肠哈特曼氏囊肠套叠虽然罕见,但对于患有哈特曼氏囊并出现呕吐和血便的患者,应排除肠套叠的可能。
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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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