小结
定义
肠旋转不良是指在胚胎发育时期发生的所有肠旋转、固定异常的疾病。
异常的盲肠与右上腹腔的连接（例如 Ladd 带）可以横跨十二指肠降部，导致十二指肠外程度较低的梗阻，可能以部分肠梗阻为表现。然而，最常见肠旋转不良的病理改变是肠管与后腹膜的连接缺失，以及中肠肠系膜的基底部较窄，从而导致小肠扭转表现为中肠扭转。这些情况可以导致十二指肠的突然梗阻，引起胆汁性呕吐。[Figure caption and citation for the preceding image starts]: 肠旋转不良伴肠扭转导致十二指肠完全梗阻，在上消化道造影上表现为十二指肠影到左侧不显影。来自Dr S.D.St Peter [Citation ends].
如果在基部的扭转同时阻断了肠系膜上动脉的血流，所有的小肠的和近端结肠将发生急性缺血并在数小时内坏死。
肠旋转不良的患者是肠扭转的高危患者，应该尽早进行相应的治疗。
病史和体格检查
关键诊断因素
- 胆汁性呕吐
- 腹痛
其他诊断因素
- <1岁的婴儿
- 腹部检查结果正常
- 腹胀
- 腹部压痛
- 心动过速伴高血压
- 心动过速伴低血压
- 呼吸急促
- 体重减轻
- 尿布上陈旧血迹
- 反跳痛和肌紧张
危险因素
- 胚胎异常
诊断性检查
首要检查
- 上消化道造影
- 腹部 CT（口服和静脉注射造影剂）
- 腹部平片
- 全血细胞计数 (FBC）
需考虑的检查
- 超声
- 下消化道连续造影
- 动脉血气 (ABG)
治疗流程
肠梗阻伴缺血
肠梗阻不伴缺血
间断或部分性肠扭转或Ladd带梗阻
可疑肠扭转不良或无症状发现者
撰稿人
作者
Fizan Abdullah, MD, PhD
Pediatric Surgery Division Head & Vice Chair Department of Surgery
Program Director, Fellowship in Pediatric Surgery
Ann & Robert H. Lurie Children's Hospital of Chicago
Professor of Surgery
Northwestern University Feinberg School of Medicine
Chicago
IL
利益声明
FA declares that he has no competing interests.
Omar Karim, MD
Clinical Fellow in Surgery
Harvard Medical School
Boston
MA
利益声明
OK declares that he has no competing interests.
鸣谢
Dr Fizan Abdullah and Dr Omar Karim would like to gratefully acknowledge Dr Stephen Shew and Dr S.D. St Peter, previous contributors to this monograph. SS is the author of two references cited in this monograph. SDSP is the co-author of one reference cited in this monograph.
同行评议者
Casey M. Calkins, MD
Assistant Professor of Pediatric Surgery
The Medical College of Wisconsin
Children's Hospital and Health System
Milwaukee
WI
利益声明
CC declares that he has no competing interests.
Steve Rothenberg, MD
Chief of Pediatric Surgery
Chairman Department of Pediatrics
The Rocky Mountain Hospital for Children at Presbyterian/St. Luke's
Denver
CO
利益声明
SR declares that he has no competing interests.
KuoJen Tsao, MD
Assistant Professor
Department of Pediatric Surgery
University of Texas Health Science Center at Houston
Houston
TX
利益声明
KT declares that he has no competing interests.
Eric Nicholls, MD
Consultant Paediatric Surgeon
Paediatric Surgery
St George's Hospital
London
UK
利益声明
EN declares that he has no competing interests.
鉴别诊断
- 十二指肠闭锁/蹼
- 肠套叠
- 胃食管返流
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