A Rare Case of Small Bowel Obstruction in a 15-Year-Old Girl: Internal Hernia Associated with Meckel's Diverticulum.

David Daoyong Lai, Xi Zhen Low, Yang Yang Lee, Weizhong Jonathan Sng
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Abstract

BACKGROUND Meckel's diverticulum is a congenital remnant of the omphalomesenteric duct and is the most common congenital gastrointestinal malformation. Most patients are asymptomatic, but a rare presentation is with subacute small bowel obstruction (SBO) due to herniation of bowel loops through an internal hernia formed by the Meckel's diverticulum and adjacent mesentery that forms an internal hernia. This report is of a 15-year-old girl presenting as an emergency with vomiting and small bowel obstruction due to an internal hernia associated with Meckel's diverticulum. CASE REPORT We present a case of a 15-year-old girl who presented to the Children's Emergency (CE) department with persistent vomiting and abdominal distension and tenderness. X-rays demonstrated dilated small bowel loops, prompting admission under Pediatric Surgery (PAS). A subsequent computed tomography (CT) scan was performed, which demonstrated multiple dilated small bowel loops, confirming SBO, and a blind-ending "C-shaped" bowel loop at the region of the terminal ileum. A diagnostic laparotomy was performed, which confirmed the presence of a Meckel's diverticulum. The tip of the Meckel's diverticulum was adherent to part of the small bowel mesentery, forming an internal hernia defect through which a loop of proximal ileum had herniated, resulting in SBO. She then underwent a laparoscopy-assisted transumbilical Meckel's diverticulectomy (LATUM). The patient recovered uneventfully and was discharged on the 4th postoperative day. CONCLUSIONS In children presenting with SBO, the possibility of Meckel's diverticulum as an etiology should be considered as a differential diagnosis. Early diagnosis and prompt intervention will improve clinical outcomes and avoid complications.
15 岁女孩小肠梗阻的罕见病例:内疝伴梅克尔憩室
背景 梅克尔憩室是先天性的卵圆肠管残余,是最常见的先天性胃肠道畸形。大多数患者无症状,但由于梅克尔憩室和邻近肠系膜形成的内疝导致肠襻疝出,从而引起亚急性小肠梗阻(SBO),这种情况比较罕见。本病例是一名 15 岁女孩的急诊病例,她因内侧疝伴有梅克尔憩室而出现呕吐和小肠梗阻。病例报告 我们报告了一例 15 岁女孩的病例,她因持续呕吐、腹胀和腹痛来到儿童急诊科就诊。X 光片显示她的小肠襻扩张,因此被儿科外科(PAS)收治。随后进行了计算机断层扫描(CT),结果显示多处小肠襻扩张,证实为SBO,并在回肠末端区域发现一个盲端 "C形 "肠襻。诊断性开腹手术证实了梅克尔憩室的存在。梅克尔憩室的顶端与部分小肠系膜粘连,形成一个内疝缺损,一圈近端回肠通过该缺损疝出,导致 SBO。随后,她接受了腹腔镜辅助经脐梅克尔憩室切除术(LATUM)。患者恢复顺利,并于术后第 4 天出院。结论 在患 SBO 的儿童中,应将梅克尔憩室作为病因的可能性作为鉴别诊断考虑。早期诊断和及时干预将改善临床效果并避免并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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