Closed loop obstruction: Pictorial essay

Closed loop obstruction occurs when a segment of bowel is incarcerated at two contiguous points. The diagnosis is based on multiple transitional zones. The incarcerated loops appear in U or C form or present a radial layout around the location of the obstruction. It's very important to specify the type of obstruction because, in patients with simple bowel obstruction, a conservative approach is often advised. On the other hand, a closed loop obstruction immediately requires a surgical approach because of its high morbidity and the risk of death in case of a late diagnosis.     

A case report: Cecal volvulus caused by Meckel's diverticulum

INTRODUCTION

Meckel''s diverticulum is the most common congenital anomaly of the small intestine. Common complications related to Meckel''s diverticulum include hemorrhage, intestinal obstruction and inflammation. Acute large bowel obstruction is a rare complication of Meckel''s diverticulum and in the presented case it is caused by volvulus.

PRESENTATION OF CASE

We report a 39 year old female who presented with the diagnosis of a large bowel obstruction occurring as a result of cecal volvulus caused by adhesions of a perforated diverticulum.

DISCUSSION

The reported case presents one of the rare complications of MD, which is volvulus. The case described above presented with signs and symptoms suggestive of acute intestinal obstruction and radiological findings suggestive of cecal volvulus. The patient was taken to the operation room for exploration and we discovered the presence of a perforated MD. The main treatment of such case is to perform diverticulectomy in all symptomatic patients.

CONCLUSION

MD is mostly identified intraoperatively. Knowledge of the pathophysiologies by which MD can cause complications such as volvulus is important in order to plan management.     

Volvulus of ileal S-pouch: A rare complication of ileal pouch anal anastomoses

INTRODUCTION

Ileal pouch anal anastomosis (IPAA) after total proctocolectomy is a frequently performed surgery for medically refractory ulcerative colitis (UC). Volvulus of the ileal pouch as a complication of IPAA is extremely rare. We present a case of volvulus of S-type ileal pouch.

PRESENTATION OF CASE

A 28 year old male, with history of total proctocolectomy with IPAA for severe UC in 2009 presented with signs of bowel obstruction. Emergency laparotomy was done and a volvulus of the S-type ileal pouch was derotated and pouchpexy done.

DISCUSSION

The IPAA has a wide spectrum of complications, with obstruction of proximal small bowel occurring frequently. Volvulus of the ileal pouch is extremely rare with only 3 reported cases. Early diagnosis and intervention is important to salvage the pouch. Computed tomography (CT) may aid the diagnosis in stable patients.

CONCLUSION

The diagnosis of ileal pouch volvulus although rare, should be kept in mind when dealing with patients complaining of recurrent obstruction following IPAA.     

梅克尔憩室诱发儿童闭袢性肠梗阻的诊治体会

目的分析梅克尔憩室引起儿童急性闭袢性肠梗阻患儿的临床资料,为及时救治提供经验。方法回顾本院自2006年3月至2014年10月收治的儿童腹腔内闭袢性肠梗阻的临床资料,就梅克尔憩室引起急性肠扭转、压迫形成闭袢性肠梗阻病例的病因、发病时间、临床表现、手术方式、术中发现及预后等进行分析。结果 8年间,收治腹腔内闭袢性肠梗阻患儿共37例,其中梅克尔憩室引起者9例。在梅克尔憩室引起的闭袢性肠梗阻中,男性6例,女性3例;平均发病年龄6.5岁,开放手术6例,腹腔镜手术3例。术中证实梅克尔憩室与周围组织粘连形成闭袢7例;肠扭转2例,其中1例为梅克尔憩室引起并伴肠坏死;另1例为纤维索带引起。术中行肠管复位,肠切除肠吻合或纤维索带切除术,术后1例出现粘连性肠梗阻,保守治疗无好转行再手术。所有患儿术后恢复良好,痊愈出院,随访12个月至8年未见异常。结论梅克尔憩室是引起儿童急性闭袢性肠梗阻的主要病因之一,学龄前后期发病多见,病情进展迅速,术前确诊困难,需早期探查,挽救肠管。     

新生儿肠旋转不良合并中肠扭转的诊治分析

目的总结肠旋转不良伴中肠扭转的临床特点,为早期诊治提供参考。方法2001年5月至2011年5月我们收治54例新生儿肠旋转不良伴中肠扭转患儿,分析其临床特点对及诊治经过。结果所有患儿均以胆汁性呕吐为首发症状;伴血便22例,中肠坏死7例。中肠坏死组与非中肠坏死组的肠扭转度数相比,差异有统计学意义（P=0．003）;两组出现症状至就诊的时间比较,差异无统计学意义（P=1．000）;两组出现血便至手术开始时间比较,差异有统计学意义（P=0．002）。49例cT检查见肠系膜根部漩涡征,其中15例见肠壁增厚,腹水,扭转肠管扩张积液等。54例患儿中,7例死于中肠坏死,其余47例顺利康复。结论新生儿期发生胆汁性呕吐者,应高度警惕肠旋转不良合并中肠扭转。早期诊断、及时治疗是改善患儿预后的关键。     

肠旋转不良合并肠扭转的超声表现和诊断意义

目的:探讨肠旋转不良合并肠扭转的超声表现和诊断意义。方法:回顾性分析7例临床确诊肠扭转患者的超声图像等资料。结果:7例超声检查均清晰显示肠系膜上静脉(SMV)和肠系膜上动脉(SMA),6例SMV位于SMA左侧(换位征),1例SMV位于SMA前方(前/后位置异常);7例病例中6例显示"漩涡征"。结论:超声图像发现SMV和SMA的换位征和前/后位置异常以及漩涡征可以诊断肠扭转。     

腹腔镜辅助手术治疗成人乙状结肠冗长症

目的总结腹腔镜辅助手术治疗成人乙状结肠冗长症的临床经验。方法对18例乙状结肠冗长症患者实施腹腔镜辅助乙状结肠切除术的临床资料进行了回顾性分析总结。结果术前经钡剂灌肠造影检查获得确诊,均成功地实施了腹腔镜辅助乙状结肠切除术。术后恢复顺利,无手术并发症。随防1～4年,疗效满意,无长期腹泻者,无便秘复发、肠梗阻复发等远期并发症。结论腹腔镜辅助乙状结肠切除术具有微创外科特点,是一种可选择的治疗成人乙状结肠冗长症的有效措施。