Small Intestine Strangulation with Volvulus Caused by Adhesion Band: A Case Report

急性缺血性腸炎是一種致命、但在流行病學中並不是常見的疾病。雖然術後沾黏是很常見，但是造成小腸扭轉的卻很少見。小腸因術後造成沾黏引起的腸扭轉最後形成箝頓性腸缺血更為少見，而且在術前診斷是非常困難的。在急診的診斷，需要靠臨床醫師高度的警覺。我們報告一位病人，術中發現在腸扭轉的底部有一個因為腹壁沾黏造成的束縛帶，造成小腸的阻塞和壞死，最後開刀將壞死的部分切除。所以，即使這樣的情況很罕見，急診醫師及放射診斷醫師對於之前有接受腹部手術的病人應該要考慮這一個問題，它們的症狀在做身體檢查的時候與急性腸缺血類似，且與腹內感染引發之急性腹痛一致。我們回顧了文獻並探討此一如果延遲診斷會造成高度死亡率、少見且困難診斷的病例。

關鍵字

箝頓；小腸；沾黏；扭轉；缺血性腸炎

並列摘要

Acute ischemic bowel disease is uncommon in the general population, and can result in death. Fibrous band caused postoperative adhesion is common, but it rarely results in volvulus. Small intestine strangulation with volvulus by post- operative fibrous band is a very rare condition of the ischemia bowel, and diagnosis before surgery is difficult. In the emergency department (ED), its detection requires great alertness on the part of the physician. We presented a case with the presence of a band at the apex of the volvulus that was fixated to the parietal peritoneum formatting of the volvulus. At first, adhesive ileus was suspected and conservative treatment was given. After a period of time, it caused small intestine necrosis and obstruction of the intestine. Laparotomy was performed and the involved section of the intestine was resected. Although small intestine strangulation with adhesion is very rare, emergency physicians and radiologists should consider the diagnosis in a patient who has a medical history of abdominal operation. Their symptoms may simulate the acute ischemic bowel disease, when examining patients, presenting with acute abdominal symptoms that are consistent with an acute infectious etiology in the abdomen. We report the rare and difficult to diagnose a case, with a high mortality rate if the diagnosis is delayed, and review the relevant literature..

並列關鍵字

strangulation ； small intestine ； adhesion band ； volvulus ； ischemic bowel disease

國際替代計量

Small Intestine Strangulation with Volvulus Caused by Adhesion Band: A Case Report

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