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首页> 外文期刊>Case Reports in Surgery >Asymptomatic Intestinal Malrotation Progressing to Midgut Volvulus in a Decompensated Alcoholic Cirrhotic Adult: A Rare Scenario Requiring Special Considerations
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Asymptomatic Intestinal Malrotation Progressing to Midgut Volvulus in a Decompensated Alcoholic Cirrhotic Adult: A Rare Scenario Requiring Special Considerations

机译：无症状的肠道恶性对失代偿的酒精性Cirrhotic成人中的中肠炎（Midgut Volvular）进展：一种需要特殊考虑的罕见情景

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Intestinal malrotation usually presents in the pediatric population with midgut volvulus requiring emergency Ladd’s procedure. Rarely, it remains asymptomatic and is discovered incidentally only during adulthood when it seldom causes intestinal complications. The scenario of a cirrhotic adult being diagnosed with asymptomatic intestinal malrotation with subsequent intestinal complications is thus extremely rare and to our knowledge has not been previously reported. We describe a 56-year-old man with decompensated alcoholic cirrhosis (Child-Pugh class C, MELD score 22) who was initially observed after an incidental diagnosis of intestinal malrotation on computed tomography. Observation continued as his liver disease improved with alcohol cessation (Child-Pugh class A, MELD score 8). He later presented with a closed loop bowel obstruction secondary to midgut volvulus at the time of alcohol relapse and liver redecompensation (Child-Pugh class C, MELD score 22-29). He underwent emergency Ladd’s procedure during which his midjejunum was volvulized into an internal hernia space created by a thick Ladd’s band containing large varices. The postoperative course was complicated by ileus and loculated bacterial peritonitis. Based on our experience, we discuss special considerations with regard to the surgical technique and timing of Ladd’s procedure when encountering intestinal malrotation in a cirrhotic adult with portal hypertension.
机译：肠道恶性通常在儿科人群中呈现出含有紧急Ladd程序的中肠道群。很少，它仍然是无症状的，并且只在成年期间发现时，当它很少导致肠道并发症时，只会发现。因此，随后肠道并发症被诊断为无症状的肠道肠道患有无症状的肠道恶性的情景是极为罕见的，并且以前尚未报道我们的知识。我们描述了一名56岁的男子，含有失代偿的酒精性肝硬化（Child-Pugh级C，Meld得分22），其最初在涉及计算机断层扫描的肠道恶性诊断后最初观察到。随着他的肝脏疾病与酒精戒烟（Child-Pugh级，融合得分8）改善而继续观察。他后来呈现出在酒精复发和肝脏重复的封闭环肠梗阻，次入患者血管伏伏特（Child-Pugh Class C，Meld评分22-29）。他接受了紧急Ladd的程序，其中他的Midjejunum博物被卷入了由厚厚的Ladd的乐队群体的内部疝气空间。术后课程受到胃肠和所在的细菌性腹膜炎的复杂化。根据我们的经验，我们讨论了在遇到门户高血压肝硬化成年人中遇到肠道恶体时的手术技术和时序的特殊考虑因素。

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