成人肠旋转不良及Ladd带致中肠扭转与十二指肠梗阻:病例报告与文献复习

目的探讨成人肠旋转不良及Ladd带致中肠扭转与十二指肠梗阻的临床表现、影像特征及鉴别诊断。方法分析1例成人肠旋转不良及Ladd带致中肠扭转与十二指肠梗阻病人的临床及影像资料,并复习相关文献。结果 CT平扫示胃及十二指肠上段、降段扩张,水平段管腔局部狭窄。CT血管成像示局部肠系膜及肠管围绕肠系膜上动脉顺时针旋转,呈"漩涡征"。手术证实为成人肠旋转不良及Ladd带致中肠扭转与十二指肠梗阻。结论成人肠旋转不良及Ladd带致中肠扭转与十二指肠梗阻为一种罕见疾病,其临床表现缺乏特异性,术前误诊率较高,影像检查具有一定提示作用,大多需手术证实。

Intestinal malrotation associated with midgut volvulus and duodenal obstruction secondary to Ladd's bands inadults:case report and literature review

Objective To investigate the clinical manifestations, imaging features and differential diagnosis of intestinal malrotation associated with midgut volvulus and duodenal obstruction secondary to Ladd's bands in adults. Methods The clinical and imaging data of one adult patient with intestinal malrotation associated with midgut volvulus and duodenal obstruction secondary to Ladd's bands were analyzed, and the related literatures were reviewed. Results CT scan revealed dilatation of stomach and the 1st and 2nd parts of the duodenum, and stenosis of the 3rd part of the duodenum. CT angiography showed local mesentery and bowel rotated clockwise around the superior mesenteric artery , presenting"whirlpool sign". The surgery confirmed intestinal malrotation associated with midgut volvulus and duodenal obstruction secondary to Ladd's bands. Conclusions In adults, the intestinal malrotation associated with midgut volvulus and duodenal obstruction secondary to Ladd's bands is a rare disease, its clinical manifestations are lack of specificity, and the rate of preoperative misdiagnosis is high. Imaging examination is helpful, but most of cases need to be confirmed by surgery.