倒置的梅克尔憩室是导致儿童肠套叠的原因之一:病例报告

M. A. Chundokova, M. A. Golovanev, Andrey A. Ivanov
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引用次数: 0

摘要

肠套叠的原因之一是存在梅克尔憩室。虽然梅克尔憩室是最常见的胃肠道异常,但世界文献中也有因梅克尔憩室内翻进入回肠腔而导致肠套叠的个别病例。病例描述患者是一名两岁 11 个月大的男孩,因阵发性腹痛和单次呕吐被救护车送往医院。触诊发现下腹痛,但无腹膜刺激症状。患儿接受了腹腔超声波检查,结果显示右下腹大肠和小肠肠壁呈分层结构。因此,肠套叠的诊断成立。在气腹镜检查时,试图保守地将肠套叠拉直,但效果不佳。于是紧急进行了腹腔镜检查,确诊为回盲肠肠套叠,并在没有技术困难的情况下将其消除。在对回肠进行检查时,发现在距回盲角 30 厘米处的肠管前缘有一个火山口状的凹陷,凹陷处有致密的组织伸入肠腔。手术继续进行,在右髂部进行了小切口手术。用手将梅克尔憩室从回肠倒置,在底部打结,然后将残端浸入荷包缝合线中切断。术后一切正常。术后第 5 天,患儿顺利出院回家。对于 1 岁儿童的肠套叠,除了梅克尔憩室倒置的可能性外,必须排除解剖学原因。因此,在成功切除肠道后,有必要对回肠进行彻底修整。
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Inverted Meckel’s diverticulum as a cause of intestinal intussusception in a child: A case report
One of the causes of intussusception is the presence of Meckel’s diverticulum. Although Meckel’s diverticulum is the most common anomaly of the gastrointestinal tract, isolated cases of intussusception caused by the inversion of Meckel’s diverticulum into the lumen of the ileum have been described in world literature. Description of case. The patient was a 2-year-11-month boy who was transported by an ambulance team, with complaints of paroxysmal abdominal pain and single vomiting. Palpation revealed lower abdominal pain without signs of peritoneal irritation. The child underwent an ultrasound examination of the abdominal cavity, which revealed a layered structure consisting of the wall of the large and small intestines in the right lower quadrant. Thus, a diagnosis of intussusception was established. An attempt to conservatively straighten the intussusception during pneumoirrigoscopy was ineffective. Emergency laparoscopy was performed, and ileocecal intussusception was diagnosed, which was eliminated without technical difficulties. During the inspection of the ileum, a crater-shaped depression with a dense formation extending from it into the intestinal lumen was discovered on its antimesenteric edge 30 cm from the ileocecal angle. The operation was continued with a minilaparotomy in the right iliac region. Meckel’s diverticulum was manually inverted from the ileum, tied at the base, and cut off with the stump immersed in a purse-string suture. The postoperative period was event-free. On day 5 after the operation, the child was discharged home in a satisfactory condition. For any intussusception in children aged 1 year, the anatomical causes must be excluded, except for the possibility of an inverted Meckel’s diverticulum. Therefore, after successful intestinal disinvagination, a thorough revision of the ileum is necessary.
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