小儿小肠扭转伴大肠系膜缺损:急腹症的不寻常表现

Dr. Rohit Mittal, Dr. Vinita Chaturvedi, Dr. Neeraj Tuteja, Dr. Atul Kumar Khare
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摘要

简介:在儿童中,由于肠系膜缺陷引起的小肠绞窄的内疝是一种罕见的肠梗阻原因。因此,早期诊断和早期治疗是小儿急诊科治疗本病的重要因素。目的:本病例报告,目的是研究小儿小肠扭转合并大肠系膜缺损,这是一种非常罕见的病例。方法与材料:1例2岁零8个月男患儿以腹痛、呕吐(胆汁)、不大便2天就诊于我院急诊科。x线表现显示,内疝是上腹部肠袢的气体膨胀,下腹部气体缺乏。主要是病人生命稳定和紧急手术计划。剖腹探查,大肠系膜缺损闭合。坏疽节段切除,末端回肠造口,远端粘液瘘形成。患者于第6次顺利出院。结论:早期诊断和早期治疗是重要的。治疗此病最重要的一步是早期诊断急性肠梗阻的体征和症状,如压痛、僵硬、呕吐和腹部疼痛。因此,在小儿急诊科急腹症的鉴别诊断中,应重视腹内疝的诊断。
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Small bowel volvulus with large mesenteric defect in paediatric patient: An unusual presentation of acute abdomen
Introduction: In children, internal herniation with small bowel strangulation due to the cause of a mesenteric defect is a rare cause of intestinal obstruction. So early diagnosis and early treatment in the pediatric emergency department are important factor for this disease. Aim: This case report, aim is to study the small bowel volvulus with large mesenteric defect in pediatrics patient, which is very rare. Methods and materials: A male child of 2 year and 8-month-old came to the emergency department of our institute with complains of abdominal pain, vomiting (bilious) and not passing stool for 2 days. On radiographic findings shows that, internal herniation is gaseous distension of the bowel loops in the upper abdominal area with a paucity of gas in the lower abdomen. Primarily patient vitally stabilized and plan for emergency operation. Exploratory laparotomy done and large mesenteric defect closed. Gangrenous segment resected and end ileostomy done with distal mucous fistula formation. Patient discharged successfully on 6th pod. Conclusion: Early diagnosis and treatment is very important in these patients. The most important step for this disease is early diagnosis of acute intestinal obstruction sign and symptoms like-tenderness, guarding and rigidity also vomiting and painful abdomen. So, it is very important that, Internal herniation should be considered in differential diagnoses of acute abdomen in the Pediatric Emergency Department.
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