儿童中肠旋转不良及扭转的分析

文章报道了30例年长儿童的中肠旋转不良及扭转，讨论了中肠旋转不良的病理解剖和发病机制。作者认为X线检查，尤其是钡剂灌肠对正确诊断非常重要，X线征象包括（1）立位平片显示“双泡”征；（2）胃肠钡餐出现十二指肠梗阻，（3）钡剂灌肠见盲肠中线、左位或肝下。     

婴儿肠旋转不良合并中肠扭转X线诊断

目的：评价腹部平片对婴儿肠旋转不良合并中肠扭转的诊断价值。材料与方法：经手术证实的婴儿肠旋转不良合并中肠扭转共１６例,结合手术＝病理回顾性分析其腹部平片表现。结果：（１）十二指肠完全性梗阻１６例,呈双球征１３例,三球征３例。（２）管状充 、狭细短跨度伴肠壁增厚肠段１５例。局限于右中上腹９例,中上腹５例,左上腹１例。（３）广泛充气扩张管形壁厚肠段,腔内有浅液面,类似小肠低位梗阻１例,结论：腹部平片简     

婴儿肠旋转不良合并中肠扭转X线诊断(附16例报告)

目的: 评价腹部平片对婴儿肠旋转不良合并中肠扭转的诊断价值。材料与方法: 经手术证实的婴儿肠旋转不良合并中肠扭转共16 例,结合手术病理回顾性分析其腹部平片表现。结果: (1) 十二指肠完全性梗阻16 例,呈双球征13 例,三球征3 例。(2) 管状充气、狭细短跨度伴肠壁增厚肠段15 例。局限于右中上腹9 例,中上腹5 例,左上腹1 例。(3) 广泛充气扩张管形壁厚肠段,腔内有浅液面,类似小肠低位梗阻1 例。结论: 腹部平片简便易行,能迅速提供肠道气体的异常信息。通过腹部平片反映本病的两个特殊病理,包括十二指肠机械梗阻和中肠扭转的动力性损害。结合空肠袢异位征象,即肠袢局限偏侧分布特征,能对本病作出早期诊断,及时手术避免肠坏死的致命后果     

超声对先天性肠旋转不良并中肠扭转的诊断价值

目的:探讨超声对先天性肠旋转不良并中肠扭转的诊断价值。方法:收集42例先天性肠旋转不良患儿的临床资料,并将超声诊断结果与手术结果进行对比分析。结果:42例中,36例合并中肠扭转(85.7%)。超声诊断肠旋转不良34例(均合并中肠扭转),敏感度94.4%(34/36);漏诊8例;6例未合并中肠扭转的患儿超声未检出。结论:彩色多普勒超声可通过显示肠系膜上动脉与肠系膜上静脉的位置关系,以及中上腹部螺旋状的软组织团块影对该病作出明确诊断,可作为术前诊断的首选检查方法。但对不合并中肠扭转的肠旋转不良患儿,超声诊断能力有限,需结合X线造影等其他检查协助诊断。     

肠旋转不良伴中肠扭转的CT诊断

目的：研究CT对肠旋转不良伴中肠扭转（volvuhus in intestinal malrotation,VIM)的诊断价值。方法：回顾性分析6例手术证实的VDIM的CT表现。男5例,女1例,年龄7～25岁,平均13岁。结果：6例均表现为肠系膜根部类团块影,其中4例见典型“漩涡征”,2例呈类“靶征”,但增强扫描亦出现“漩涡征”。毗邻部肠袢扩张,肠系膜静脉不同程度淤积扩张,2例伴受累系膜、肠壁重度水肿。6例均见系膜根部肠系膜上动脉（superior mesenteric artery,SMA）、肠系膜上静脉（superior mesenteric vein,SMV)血管正常排列迷失。结论：“漩涡征”伴系膜根部SMA、SMV正常排列迷失为本病的特征性CT表现。     

小儿肠旋转不良的超声诊断

目的:探讨小儿肠旋转不良的超声表现。材料和方法:回顾性分析20例经手术证实为肠旋转不良的超声资料。观察肠系膜上动脉与肠系膜上静脉的位置关系。结果:17例根据肠系膜上动脉和肠系膜上静脉的位置关系异常超声诊断为肠旋转不良伴中肠扭转,2例诊断为混杂性肿块,1例超声阴性。结论:超声检查可根据肠系膜上动脉和肠系膜上静脉的位置改变诊断肠旋转不良,“旋窝征”有助于伴发中肠扭转的诊断。     

先天性肠旋转不良伴肠扭转合并马蹄肾1例

患者女,24岁.无明显诱因出现恶心、呕吐2月余,加重2周为主诉入院.体检:发育正常,营养中等,自主体位,神志清,精神差;心肺听诊无异常,腹胀,肝脾肋下未触及,神经系统检查无异常.实验室检查:WBC 12.9×109/L,RBC 3.89×1012/L,电解质:k+3.73mmol/L,Na+127.6mmol/L,Cl-89.4mmol/L,Ca2+ 2.7mmol /L.     

MSCT在诊断成人先天性中肠旋转不良中的应用价值

目的 探讨MSCT在诊断成人中肠旋转不良中的应用价值及其优越性.方法 回顾性分析8例中肠旋转不良患者的MSCT影像资料,按照外科分型对其MSCT征象进行分析.结果 8例患者中,肠旋转不完全4例,肠旋转异常3例,结肠反向旋转1例合并脂肪瘤.结论 MSCT对于诊断成人中肠旋转不良具有一定的优势,可以帮助临床制定合理的治疗方案及评估患者预后.     

良性十二指肠淤滞症伴先天性小肠旋转不良1例

我院 1999年收治了 1例良性十二指肠淤滞伴先天性小肠旋转不良的患者 ,现将治疗体会报告如下。1　资料和方法　患者 ,男 ,17岁 ,学生。于 1994年 8月开始无明显诱因出现上腹胀痛 ,进食后加重 ,伴低热 ,呈间断性发作 ,被当地医院以“急性胃炎”收治。 1999年 5月被诊断为“急性阑尾炎”并行阑尾切除术。术后第 4天出现腹胀、腹痛 ,伴恶心、呕吐 ,呕吐物为胃内容物 ,给予胃肠持续减压 ,维持水电解质平衡 ,抗炎治疗 ,仍无明显好转 ,于术后 7ｄ来我院求治。查体发育正常 ,消瘦 ,腹部呈舟状 ,右下腹可见一约5ｃｍ长麦式切口瘢痕 ,脐右可见肠型。…     

Chylolymphatic mesenteric cyst with midgut volvulus in an adolescent: a peculiar presentation

Mesenteric cysts are rare intra-abdominal masses in the pediatric population, with the chylolymphatic variant comprising only 7.3% of all abdominal cysts. These cysts can have a varied clinical presentation, ranging from asymptomatic cystic masses to intestinal obstruction. We report a 16-year-old female, who presented with acute abdominal pain and vomiting, and was diagnosed with an intra-abdominal cystic mass with midgut volvulus accompanied by the classical “whirlpool sign” on imaging.She underwent laparoscopic abdominal exploration, which revealed a large chylolymphatic mesenteric cyst associated with feeder lymph vessels. This cyst had resulted in volvulus of the small bowel. The bowel was detorsed and found to be viable, and the cyst was removed en bloc after suction evacuation with ligation of the lymphatic feeder vessels.Midgut volvulus in the pediatric population is usually secondary to malrotation, but in this case the patient''s small intestine was not found to be malrotated, and hence we present this case and urge physicians to consider a diagnosis of midgut volvulus even in the absence of malrotation in a child with a cystic abdominal mass presenting as intestinal obstruction.     

CT angiographic demonstration of a mesenteric vessel "whirlpool" in intestinal malrotation and midgut volvulus: a case report

Although the color Doppler ultrasonography diagnosis of intestinal malrotation with midgut volvulus, based on the typical "whirlpool" appearance of the mesenteric vascular structures is well-defined in the peer-reviewed literature, the combination of both the angiographic illustration of these findings and the contemporary state-of-the-art imaging techniques is lacking. We report the digital subtraction angiography and multidetector computed tomography angiography findings of a 37-year-old male with intestinal malrotation.     

Midgut volvulus in an adult patient with malrotation and abdominal heterotaxia: a case report

Midgut volvulus is rare in adulthood and if not diagnosed accurately, carries a high mortality rate. We present a case of a young adult man who presented with acute abdominal pain and was found to have malrotation with abdominal heterotaxia. Abdominal computed tomography can identify anomalies associated with intestinal malrotation. With the awareness of the potential for malrotation to predispose to midgut volvulus, the patient and his physician will have a higher index of suspicion when abdominal pain occurs. Appropriate treatment of midgut volvulus will reduce morbidity and mortality.     

Acute pancreatitis secondary to intramural duodenal hematoma: Case report and literature review

Nontraumatic intramural duodenal hematoma (IDH) is rare disease and it is generally related to coagulation abnormalities. Reports of nontraumatic IDH associated with pancreatic disease are relatively rare, and various conditions including acute or chronic pancreatitis are thought to be associated with nontraumatic IDH. However, the association between IDH and acute pancreatitis remains unknown. We report the case of a 45-year-old man who presented with vomiting and right hypochondrial pain. He had no medical history, but was a heavy drinker. The diagnosis of IDH was established by computed tomography, ultrasonography and endoscopy, and it was complicated by acute pancreatitis. The lesions resolved with conservative management. We discuss this case in the context of previously reported cases of IDH concomitant with acute pancreatitis. In our patient, acute pancreatitis occurred concurrently with hematoma, probably due to obstruction of the duodenal papilla, or compression of the pancreas caused by the hematoma. The present analysis of the published cases of IDH with acute pancreatitis provides some information on the pathogenesis of IDH and its relationship with acute pancreatitis.     

手术治疗二尖瓣附瓣致左室流出道狭窄2例报告

目的探讨二尖瓣附瓣造成左室流出道狭窄的临床特点及手术治疗.方法收治两例二尖瓣附瓣合并左室流出道狭窄畸形.例1术前诊断先天性心脏病,二尖瓣叶裂,左心室流出道重度狭窄;例2术前诊断先天性心脏病,房间隔缺损,二尖瓣附瓣,二尖瓣轻中度关闭不全,左室流出道轻度狭窄.两例手术均在中低温体外循环下进行,例1经主动脉瓣探查发现二尖瓣附瓣附着在二尖瓣前叶基底部的心室面,为固定型,造成左室流出道狭窄;例2二尖瓣附瓣通过一个蒂与二尖瓣前叶基部相连,为活动型.结果均经房间隔将二尖瓣附瓣切除,合并心脏畸形一并矫治,术后恢复顺利,主动脉瓣下狭窄基本或完全解除.结论二尖瓣附瓣致左室流出道狭窄畸形较为罕见,狭窄明显者必须进行手术治疗;对于无或轻度左室流出道狭窄及未合并其它心脏畸形的二尖瓣附瓣,无需进行预防性手术,但必须定期随访.     

Granulomatosis with polyangiitis: A case report and brief review of literature

Granulomatosis with polyangiitis formerly known as Wegener''s granulomatosis was first described by German pathologist Friedrich Wegener in 1936. It is a multi-system necrotizing noncaseating granulomatous vasculitis which affects small to medium-sized vessels. It can involve any organ system, most commonly the lungs and kidneys. American College of Rheumatology requires 2 of 4 criteria for diagnosis: Positive biopsy for granulomatous vasculitis, urinary sediment with red blood cells, abnormal chest radiograph and oral/nasal inflammation. Here we present a case of Granulomatosis with polyangiitis with brief review of literature.     

Sigmoid lipoma as an exceptional cause of intussusception and bowel obstruction in adults: A case report and review of literature

Acute intestinal intussusception in adults is a rare condition, most often secondary to an organic lesion (tumor or inflammation), representing 1%-5% of intestinal obstructions. Pure colic intussusception on lipoma rectal causing bowel obstruction is an exceptional situation. A 60-year-old man presented to the emergency department for acute abdominal pain with marked abdominal distention and red rectal bleeding. A contrast-enhanced abdominal CT scan was performed, which revealed a recto-sigmoid intussusception on lipoma, causing mechanical intestinal obstruction. The patient underwent a partial reduction of the intussusception with partial sigmoid resection and end colostomy. Colonic lipomas of the recto-sigmoid region represent a very rare condition and a subsequent etiology for intussusception and bowel obstruction in adults. However, it should be considered in the differential diagnosis of such situations.     

Ehlers-Danlos syndrome with a spontaneous caroticocavernous fistula occluded by detachable balloon: case report and review of literature

We report a caroticocavernous fistula (CCF) treated by an endovascular procedure in a young woman with Ehlers-Danlos syndrome type IV, with severe bilateral carotid and vertebral artery dysplasia. The CCF, which appeared after minor trauma, was successfully occluded by a detachable balloon introduced into the venous side by an arterial approach. Six previously published cases are reviewed, five successfully treated. The difficulties and risks of the endovascular procedure due to the vascular changes, are emphasised. The possibility of the venous approach is discussed.     

A lethal form of Gorham disease associated with extensive musculoskeletal pneumatosis: case report and review of the literature

We report here the imaging findings of a rare case of a lethal form of Gorham disease in a young female patient. Multimodality imaging findings over 13 year-follow-up demonstrated progressive wide spread skeletal and soft tissue abnormalities with permeative osteolysis, pathological fractures and severe skeletal deformities. Unusual extensive osseous and soft tissue pneumatosis was illustrated on cross-sectional studies. The progressive nature of this form of Gorham disease and the subsequent complications eventually culminated in patient’s death.     

Sternoclavicular physeal fracture associated with adjacent clavicle fracture in a 14-year-old boy: a case report and literature review

We report a very rare association of a physeal fracture of the medial clavicular growth plate with a fracture of the adjacent clavicle in a 14-year-old boy who fell on his shoulder while playing football. Clinical, radiographic and computed tomographic (with three-dimensional reconstruction) features are described. Open reduction, internal fixation of the lateral fracture (with a reconstructive plate) and suture of the periosteum were performed.