Congenital Intestinal Malrotation in an Adult: A Case Report

成人先天性腸道旋轉不良：病例報告

浦大維(Ta-Wei Pu) ； 李家政(Chia-Cheng Lee) ； 張玉樺(Yu-Hua Chang) ； 蕭正文(Cheng-Wen Hsiao) ； 吳昌杰(Chang-Chieh Wu) ； 饒樹文(Shu-Wen Jao) ； 陳昭仰(Chao-Yang Chen) ； 糠榮誠(Jung-Cheng Kang) ； 吳柏憲(Po-Hsien Wu) ； 胡哲銘(Je-Ming Hu) ； 江明倫(Ming-Lun Chiang)

《中華民國大腸直腸外科醫學會雜誌》 28卷4期 (2017/12) Pp. 212-216

https://doi.org/10.6312/SCRSTW.2017.28(4).10611

摘要

Purpose: To describe our experience using barium studies and computed tomography (CT) to diagnose midgut malrotation in an adult. Methods: Barium studies and CT were used to diagnose midgut malrotation in a 60-year-old man who had intermittent chronic abdominal pain for several months. Results: Abdominal CT without contrast indicated complete malrotation of the bowel. Results of the barium enema showed that the ascending colon and transverse colon had left-sided deviation. The patient was radiologically diagnosed as having malrotation, but he had not yet undergone an operation. He reported only experiencing mild symptoms and wished to receive conservative treatment. Conclusions: Midgut malrotation should be considered in the differential diagnosis in patients presenting with chronic abdominal pain. A physical examination and imaging studies may help the surgeon make an accurate diagnosis.

關鍵字

Midgut malrotation ； Volvulus ； Adult ； Computed tomography ； Barium enema

並列摘要

目的：本病例我們使用鋇劑攝影和電腦斷層掃描來診斷成年人中腸旋轉不良。方法：將鋇劑攝影和電腦斷層掃描用於診斷慢性腹痛多月的60歲男性的中腸旋轉不良。結果：無顯影劑腹部電腦斷層掃描診斷腸道旋轉不良。鋇劑攝影顯示升結腸和橫結腸左側偏差。這名患者雖然診斷出腸道旋轉不良，但他認為目前只經歷輕微的症狀，並希望採取保守治療。結論：鑑別診斷慢性腹痛患者時應考慮中腸旋轉不良這個診斷。理學檢查和影像輔助可使外科醫生準確診斷中腸旋轉不良。

並列關鍵字

中腸旋轉不良 ； 扭轉 ； 成人 ； 電腦斷層掃描 ； 鋇劑攝影

參考文獻

1. Zengin A, Ucar BI, Duzgun SA, Bayhan Z, Zeren S, Yaylak F, et al. Adult midgut malrotation presented with acute bowel obstruction and ischemia. Int J Surg Case Rep 2016;22:5-7.

2. Emanuwa OF, Ayantunde AA, Davies TW. Midgut malrotation first presenting as acute bowel obstruction in adulthood: a case report and literature review. World J Emerg Surg 2011;6:22.

3. Palepu RP, Harmon CM, Goldberg SP, Clements RH. Intestinal malrotation discovered at the time of laparoscopic Roux-en-Y gastric bypass. J Gastrointest Surg 2007;11:898-902.

4. Wanjari AK, Deshmukh AJ, Tayde PS, Lonkar Y. Midgut malrotation with chronic abdominal pain. N Am J Med Sci 2012;4:196-8.

5. Ameh EA, Nmadu PT. Intestinal volvulus: aetiology, morbidity, and mortality in Nigerian children. Pediatr Surg Int 2000;16:50-2.