青少年无肠旋转不良的中肠扭转1例

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports Pub Date : 2025-07-10 DOI:10.1016/j.epsc.2025.103056

Yasmine Houas, Alma Baccouche, Nader Bennour Ghaddab, Sirine Fkaier, Riadh Jouini

{"title":"青少年无肠旋转不良的中肠扭转1例","authors":"Yasmine Houas, Alma Baccouche, Nader Bennour Ghaddab, Sirine Fkaier, Riadh Jouini","doi":"10.1016/j.epsc.2025.103056","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Midgut volvulus is a life-threatening surgical emergency typically associated with intestinal malrotation in neonates and infants. However, midgut volvulus without malrotation is rare and often underrecognized, particularly in older children, leading to delays in diagnosis and management.</div></div><div><h3>Case presentation</h3><div>We present the case of a previously healthy 13-year-old male with a one-week history of intermittent, crampy abdominal pain and bilious vomiting. He was initially diagnosed with viral gastroenteritis and treated symptomatically, but symptoms persisted and worsened. On admission, he was afebrile but had a distended, tender abdomen without signs of peritonitis. Abdominal X-rays were inconclusive, showing nonspecific bowel gas patterns. An abdominal ultrasound showed no definitive abnormalities. Due to ongoing symptoms, a contrast-enhanced abdominal computed tomography (CT) scan was performed, revealing a classic “whirlpool sign” of the superior mesenteric vessels and proximal bowel dilation. The patient underwent emergency exploratory laparotomy. Intraoperatively, a 360° midgut volvulus was found, caused by congenital mesenteric adhesions. The bowel appeared viable. Detorsion and complete adhesiolysis were performed without the need for resection. The postoperative course was uneventful: oral feeding was reinitiated on postoperative day 2, and the patient was discharged on postoperative day 6. At three-month follow-up, he remained asymptomatic with no signs of recurrence.</div></div><div><h3>Conclusion</h3><div>Midgut volvulus must be included in the differential diagnosis of teenagers who develop abdominal pain and/or bilious emesis.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"120 ","pages":"Article 103056"},"PeriodicalIF":0.2000,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Midgut volvulus without intestinal malrotation in a teenager: a case report\",\"authors\":\"Yasmine Houas, Alma Baccouche, Nader Bennour Ghaddab, Sirine Fkaier, Riadh Jouini\",\"doi\":\"10.1016/j.epsc.2025.103056\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>Midgut volvulus is a life-threatening surgical emergency typically associated with intestinal malrotation in neonates and infants. However, midgut volvulus without malrotation is rare and often underrecognized, particularly in older children, leading to delays in diagnosis and management.</div></div><div><h3>Case presentation</h3><div>We present the case of a previously healthy 13-year-old male with a one-week history of intermittent, crampy abdominal pain and bilious vomiting. He was initially diagnosed with viral gastroenteritis and treated symptomatically, but symptoms persisted and worsened. On admission, he was afebrile but had a distended, tender abdomen without signs of peritonitis. Abdominal X-rays were inconclusive, showing nonspecific bowel gas patterns. An abdominal ultrasound showed no definitive abnormalities. Due to ongoing symptoms, a contrast-enhanced abdominal computed tomography (CT) scan was performed, revealing a classic “whirlpool sign” of the superior mesenteric vessels and proximal bowel dilation. The patient underwent emergency exploratory laparotomy. Intraoperatively, a 360° midgut volvulus was found, caused by congenital mesenteric adhesions. The bowel appeared viable. Detorsion and complete adhesiolysis were performed without the need for resection. The postoperative course was uneventful: oral feeding was reinitiated on postoperative day 2, and the patient was discharged on postoperative day 6. At three-month follow-up, he remained asymptomatic with no signs of recurrence.</div></div><div><h3>Conclusion</h3><div>Midgut volvulus must be included in the differential diagnosis of teenagers who develop abdominal pain and/or bilious emesis.</div></div>\",\"PeriodicalId\":45641,\"journal\":{\"name\":\"Journal of Pediatric Surgery Case Reports\",\"volume\":\"120 \",\"pages\":\"Article 103056\"},\"PeriodicalIF\":0.2000,\"publicationDate\":\"2025-07-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Pediatric Surgery Case Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2213576625001010\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatric Surgery Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2213576625001010","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PEDIATRICS","Score":null,"Total":0}

引用次数: 0

摘要

中肠扭转是一种危及生命的外科急症，通常与新生儿和婴儿肠道旋转不良有关。然而，没有旋转不良的中肠扭转是罕见的，经常被忽视，特别是在年龄较大的儿童中，导致诊断和治疗的延误。病例介绍：我们报告一名13岁的健康男性，有一周的间歇性腹痛和胆汁性呕吐史。他最初被诊断为病毒性肠胃炎并进行了对症治疗，但症状持续并恶化。入院时，他发烧，但腹部肿胀，柔软，没有腹膜炎的迹象。腹部x光不确定，显示非特异性肠道气体。腹部超声检查没有明确异常。由于症状持续，进行了增强腹部计算机断层扫描（CT），显示肠系膜上血管和近端肠扩张的典型“漩涡征”。患者接受了紧急剖腹探查术。术中发现先天性肠系膜粘连引起的360°中肠扭转。肠道似乎还能存活。在不需要切除的情况下进行扭曲和完全粘连松解。术后过程顺利：术后第2天重新开始口服喂养，患者于术后第6天出院。随访3个月，患者无症状，无复发迹象。结论青少年腹痛和/或胆汁性呕吐的鉴别诊断应包括中肠扭转。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Midgut volvulus without intestinal malrotation in a teenager: a case report

Introduction

Midgut volvulus is a life-threatening surgical emergency typically associated with intestinal malrotation in neonates and infants. However, midgut volvulus without malrotation is rare and often underrecognized, particularly in older children, leading to delays in diagnosis and management.

Case presentation

We present the case of a previously healthy 13-year-old male with a one-week history of intermittent, crampy abdominal pain and bilious vomiting. He was initially diagnosed with viral gastroenteritis and treated symptomatically, but symptoms persisted and worsened. On admission, he was afebrile but had a distended, tender abdomen without signs of peritonitis. Abdominal X-rays were inconclusive, showing nonspecific bowel gas patterns. An abdominal ultrasound showed no definitive abnormalities. Due to ongoing symptoms, a contrast-enhanced abdominal computed tomography (CT) scan was performed, revealing a classic “whirlpool sign” of the superior mesenteric vessels and proximal bowel dilation. The patient underwent emergency exploratory laparotomy. Intraoperatively, a 360° midgut volvulus was found, caused by congenital mesenteric adhesions. The bowel appeared viable. Detorsion and complete adhesiolysis were performed without the need for resection. The postoperative course was uneventful: oral feeding was reinitiated on postoperative day 2, and the patient was discharged on postoperative day 6. At three-month follow-up, he remained asymptomatic with no signs of recurrence.