PDF(Pubmed)
Abstract：
BACKGROUND: Long tubular duplication is a rare congenital intestinal disease, that can lead to emergency situations marked by massive hemorrhage. However, preoperative diagnosis and surgical treatment are challenging. This report presents preoperative images and details a surgical procedure for long tubular intestinal duplications with massive hemorrhage.
METHODS: A 3-year-old boy presented to the emergency department with melena. Despite undergoing a Tc-99m pertechnetate scintigraphy one year prior, which revealed nonspecific findings with enhancement of some parts of the intestine, enhanced abdominal CT revealed an edematous small intestine with luminal extravasation. The patient received a transfusion of red blood cells; however, his hemoglobin level did not improve. Arterial angiography and double-balloon endoscopy revealed no remarkable findings. Exploratory laparotomy revealed a long tubular duplication in half of the small intestine. Utilizing the Wrenn procedure, we successfully removed all duplicate mucosa. Pathological findings showed that almost all duplications contained gastric mucosa and revealed an ulcer with a ruptured arterial vessel. His symptoms were resolved, and the hemoglobin level stabilized. At 2 months postoperatively, no surgical complications were present.
CONCLUSIONS: Effective management of long tubular duplications with massive hemorrhage involves timely application of the Wrenn procedure. Recognition of specific imaging findings is crucial to prompt exploratory laparotomy, ensuring optimal outcomes and preventing delays in treatment.
METHODS: A 3-year-old boy presented to the emergency department with melena. Despite undergoing a Tc-99m pertechnetate scintigraphy one year prior, which revealed nonspecific findings with enhancement of some parts of the intestine, enhanced abdominal CT revealed an edematous small intestine with luminal extravasation. The patient received a transfusion of red blood cells; however, his hemoglobin level did not improve. Arterial angiography and double-balloon endoscopy revealed no remarkable findings. Exploratory laparotomy revealed a long tubular duplication in half of the small intestine. Utilizing the Wrenn procedure, we successfully removed all duplicate mucosa. Pathological findings showed that almost all duplications contained gastric mucosa and revealed an ulcer with a ruptured arterial vessel. His symptoms were resolved, and the hemoglobin level stabilized. At 2 months postoperatively, no surgical complications were present.
CONCLUSIONS: Effective management of long tubular duplications with massive hemorrhage involves timely application of the Wrenn procedure. Recognition of specific imaging findings is crucial to prompt exploratory laparotomy, ensuring optimal outcomes and preventing delays in treatment.
摘要：
背景：长管状重复是一种罕见的先天性肠道疾病，这可能会导致大量出血的紧急情况。然而,术前诊断和手术治疗具有挑战性.本报告介绍了术前图像，并详细介绍了长管状肠重复并发大出血的外科手术。
方法：一名3岁男孩因黑便被送往急诊科。尽管一年前进行了Tc-99m高tech闪烁显像，这揭示了肠道某些部分增强的非特异性发现，增强腹部CT显示小肠水肿伴管腔外渗。患者接受了红细胞的输血；然而，他的血红蛋白水平没有改善.动脉造影和双气囊内窥镜检查没有明显发现。剖腹探查术显示小肠的一半长管状重复。利用Wrenn程序,我们成功切除了所有重复的粘膜。病理发现表明，几乎所有重复物都包含胃粘膜，并显示溃疡并有动脉血管破裂。他的症状得到了缓解,血红蛋白水平稳定.术后2个月，未出现手术并发症.
结论：有效处理长肾小管重复合并大出血包括及时应用Wrenn手术。识别特定的影像学表现对于提示剖腹探查至关重要。确保最佳结果并防止治疗延误。
方法：一名3岁男孩因黑便被送往急诊科。尽管一年前进行了Tc-99m高tech闪烁显像，这揭示了肠道某些部分增强的非特异性发现，增强腹部CT显示小肠水肿伴管腔外渗。患者接受了红细胞的输血；然而，他的血红蛋白水平没有改善.动脉造影和双气囊内窥镜检查没有明显发现。剖腹探查术显示小肠的一半长管状重复。利用Wrenn程序,我们成功切除了所有重复的粘膜。病理发现表明，几乎所有重复物都包含胃粘膜，并显示溃疡并有动脉血管破裂。他的症状得到了缓解,血红蛋白水平稳定.术后2个月，未出现手术并发症.
结论：有效处理长肾小管重复合并大出血包括及时应用Wrenn手术。识别特定的影像学表现对于提示剖腹探查至关重要。确保最佳结果并防止治疗延误。
