关键词: CT scan exploratory laparotomy multidisciplinary approach small-bowel obstruction supravesical hernia

来  源:   DOI:10.1097/MS9.0000000000002222   PDF(Pubmed)

Abstract:
UNASSIGNED: Supravesical hernias are rare internal hernias but potential cause of small-bowel obstruction. The clinical features are often non-specific, preoperative diagnosis is very difficult and is often diagnosed intraoperatively. The exact pathogenesis is unclear with the major risk factors of prematurity, a positive family history, male sex, smoking habits leading to decreased collagen production, advancing age, and conditions characterized by defective collagen synthesis.
UNASSIGNED: The authors are reporting a case of small-bowel obstruction secondary to a supravesical hernia, in a 78-year-old male presented with central abdominal pain, vomiting and obstipation. Ultrasonography of the abdomen and pelvis identified a marked dilation of the small-bowel loop with multiple loops of dilated jejunum and ileum in contrast-enhanced computed tomography (CT) scan of the abdomen and pelvis with lead point from the terminal ileum. Exploratory laparotomy was done with the diagnosis of left posterior a left posterior superior vesical hernia with small-bowel obstruction.
UNASSIGNED: The case focuses supravesical hernia as a rare yet life-threatening etiology of small-bowel obstruction, emphasizing the importance of clinical suspicion when patients present with signs and symptoms of bowel obstruction. While diagnosis often occurs intraoperatively, the utilization of CT scans in emergency settings can provide valuable insights into the location, potential causes, and condition of the herniated bowel sac. The case highlights the pivotal role of CT scans in diagnosis and emphasizes the need for multidisciplinary cooperation among clinicians, radiologists, and surgeons.
UNASSIGNED: Early intervention ensures better outcomes and prevents irreversible bowel damage, underscoring the importance of a comprehensive approach to patient care.
摘要:
膀胱上疝是罕见的内部疝,但可能是小肠梗阻的原因。临床特征通常是非特异性的,术前诊断非常困难,通常在术中诊断。确切的发病机制尚不清楚,早产的主要危险因素,有积极的家族史,男性,吸烟习惯导致胶原蛋白产生减少,年龄增长,和以胶原蛋白合成缺陷为特征的条件。
作者报告了一例继发于膀胱上疝的小肠梗阻,一名78岁的男性出现中央腹痛,呕吐和便秘。在腹部和骨盆的对比增强计算机断层扫描(CT)扫描中,腹部和骨盆的超声检查发现小肠环明显扩张,空肠和回肠有多个扩张环。进行剖腹探查术,诊断为左后上膀胱疝伴小肠梗阻。
该病例将膀胱上疝作为一种罕见但危及生命的小肠梗阻病因,强调当患者出现肠梗阻的体征和症状时临床怀疑的重要性。虽然诊断通常发生在术中,在紧急情况下利用CT扫描可以提供对位置的有价值的见解,潜在原因,和突出的肠囊的状况。该病例强调了CT扫描在诊断中的关键作用,并强调了临床医生之间多学科合作的必要性,放射科医生,还有外科医生.
早期干预可确保更好的结果并防止不可逆的肠道损伤,强调全面护理患者的重要性。
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