成人先天性小肠旋转不良一例  

Adult congenital malrotation of the intestine: a case report

作　　者：卢俊竹 陈广成[1] 詹俊[1] 

机构地区：[1]中山大学孙逸仙纪念医院消化内科,广州510030

出　　处：《新医学》2017年第9期673-676,共4页Journal of New Medicine

摘　　要：先天性小肠旋转不良是由于胚胎期时中肠的旋转及固定发生障碍,使肠管位置发生变异,从而引起肠梗阻,甚至肠扭转。成人发病罕见,症状体征不典型,容易误诊。该文报道了1例24岁男性患者,以不明原因反复腹痛1年就诊,没有明显肠梗阻症状,在排除以慢性腹痛为特征的常见疾病后,结合上腹CT加CT血管造影示空肠部分旋转至右侧腹,肠系膜上血管分支右旋至右侧腹,考虑诊断成人先天性小肠旋转不良。予对症止痛、促消化、调节胃肠动力等治疗后,行全消化道钡餐造影检查未见明确异常,患者亦诉腹痛明显缓解。请外科会诊后示患者目前无肠梗阻表现,暂无手术指征,出院后定期随访。Congenital malrotation of the intestine is a disorder caused by the rotation and fixation obstruction of the midgut during the embryonic period, which alters the bowel position, thereby leading to intestinal obstruction and even intestinal torsion.It is rarely seen in adults.It is likely to make a misdiagnosis due to non-specific symptoms and physical signs.In this article, we reported a 24-year-old male patient presenting with recurrent abdominal pain for 1 year with unknown causes.He had no evident intestinal obstruction symptoms.The possibility of common diseases characterized with chronic abdominal pain was excluded.CT scan of the upper abdomen combined with CT angiography demonstrated that partial jejunum rotated to the right abdomen and the mesenteric vascular branch rotated to the right abdomen.The diagnosis of adult congenital intestinal malrotation was considered.Analgesic drugs, digestion-promoting intervention and gastrointestinal motility therapy were delivered.Subsequently, the examination of the gastrointestinal system with a barium meal detected no evident abnormalities.He reported that the abdominal pain was significantly alleviated.Round consultation of the surgeons revealed no intestinal obstruction manifestations or surgical indications.After discharge, follow-up should be delivered on a regular basis.

关 键 词：先天性小肠旋转不良 成人 肠梗阻 Ladd手术 

分 类 号：R656.7[医药卫生—外科学]