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Abstract：
BACKGROUND: The mesodiverticular band (MDB) of a Meckel\'s diverticulum (MD) is a rare, yet notable etiology of small bowel obstruction (SBO) in adults. Due to the nonspecific symptoms and challenging diagnosis thereof, preoperative clinical suspicion and strategic management are crucial for achieving optimal outcomes. Therefore, we presented a case in which laparoscopic surgery was strategically performed to alleviate ileus, due to a preoperative diagnosis of SBO, suspected to be secondary to an MD with a concomitant MDB.
METHODS: A 32-year-old male patient presented with a half-day\'s duration of epigastric pain, abdominal distension, and tenderness, resulting in the working diagnosis of SBO.
METHODS: Initial non-contrast computed tomography (CT) revealed SBO without signs of strangulation, postulated to be caused by an MD and concomitant MDB, resulting in conservative management. The symptoms persisted, necessitating contrast-enhanced CT. However, the dilated bowel loop suggestive of an MD that had been observed on non-contrast CT could not be confirmed on contrast-enhanced CT.
METHODS: Decompression therapy using a long tube provided minimal relief, prompting laparoscopic surgery on the 5th day post-admission for diagnostic and therapeutic purposes.
RESULTS: An MD resection effectively relieved the SBO. The histopathological analysis revealed a true diverticulum with ectopic pancreatic tissue, confirming the diagnosis of an MD. At the band site, vascular and neural structures were encased in a sheath, consistent with the remnants of the vitelline duct mesentery; and histopathologically diagnosed as an MDB. The postoperative course was uneventful, and the patient was discharged on the 9th day, postoperatively.
CONCLUSIONS: Decompression therapy and strategic laparoscopic surgery based on the preoperative working diagnosis of SBO yielded favorable outcomes, highlighting the importance of the early clinical suspicion of an MD and a concomitant MDB, as the etiology of SBO. The imaging variability and rarity of an MD in adults emphasizes the need for a heightened awareness and an accurate diagnosis for optimal management. Early intervention should be deliberated for patients with suspected intestinal ischemia. However, this case accentuates the clinical implications of strategic planning and employing minimally invasive techniques in the management of an MD-related SBO in adults.
METHODS: A 32-year-old male patient presented with a half-day\'s duration of epigastric pain, abdominal distension, and tenderness, resulting in the working diagnosis of SBO.
METHODS: Initial non-contrast computed tomography (CT) revealed SBO without signs of strangulation, postulated to be caused by an MD and concomitant MDB, resulting in conservative management. The symptoms persisted, necessitating contrast-enhanced CT. However, the dilated bowel loop suggestive of an MD that had been observed on non-contrast CT could not be confirmed on contrast-enhanced CT.
METHODS: Decompression therapy using a long tube provided minimal relief, prompting laparoscopic surgery on the 5th day post-admission for diagnostic and therapeutic purposes.
RESULTS: An MD resection effectively relieved the SBO. The histopathological analysis revealed a true diverticulum with ectopic pancreatic tissue, confirming the diagnosis of an MD. At the band site, vascular and neural structures were encased in a sheath, consistent with the remnants of the vitelline duct mesentery; and histopathologically diagnosed as an MDB. The postoperative course was uneventful, and the patient was discharged on the 9th day, postoperatively.
CONCLUSIONS: Decompression therapy and strategic laparoscopic surgery based on the preoperative working diagnosis of SBO yielded favorable outcomes, highlighting the importance of the early clinical suspicion of an MD and a concomitant MDB, as the etiology of SBO. The imaging variability and rarity of an MD in adults emphasizes the need for a heightened awareness and an accurate diagnosis for optimal management. Early intervention should be deliberated for patients with suspected intestinal ischemia. However, this case accentuates the clinical implications of strategic planning and employing minimally invasive techniques in the management of an MD-related SBO in adults.
摘要：
背景：Meckel憩室（MD）的中关节带（MDB）是一种罕见的，然而，成人小肠梗阻（SBO）的显着病因。由于非特异性症状和具有挑战性的诊断，术前临床怀疑和战略管理对于获得最佳结果至关重要.因此,我们提出了一个病例，其中有策略地进行腹腔镜手术以减轻肠梗阻，由于SBO的术前诊断，怀疑是继发于伴有MDB的MD。
方法：一名32岁男性患者表现为上腹痛持续半天，腹胀,和温柔，导致SBO的工作诊断。
方法：初始非对比计算机断层扫描（CT）显示SBO没有绞窄的迹象，假设是由MD和伴随的MDB引起的，导致保守的管理。症状持续存在，需要对比增强CT。然而,在非对比CT上观察到的提示MD的扩张肠环在对比增强CT上无法证实.
方法：使用长管的减压疗法提供了最小的缓解，提示在入院后第5天进行腹腔镜手术，以达到诊断和治疗目的。
结果：MD切除可有效缓解SBO。组织病理学分析显示一个真正的憩室与异位胰腺组织，确认MD的诊断。在乐队现场，血管和神经结构被包裹在鞘中，与卵黄导管肠系膜的残留物一致；在组织病理学上被诊断为MDB。术后进展顺利，病人在第9天出院,术后。
结论：基于SBO术前工作诊断的减压治疗和策略性腹腔镜手术取得了良好的结果，强调早期临床怀疑MD和伴随的MDB的重要性，作为SBO的病因。成人MD的影像学变异性和稀有性强调了提高意识和准确诊断以实现最佳管理的必要性。对于怀疑肠缺血的患者应考虑早期干预。然而,该病例强调了在成人MD相关SBO治疗中进行战略规划和采用微创技术的临床意义.
方法：一名32岁男性患者表现为上腹痛持续半天，腹胀,和温柔，导致SBO的工作诊断。
方法：初始非对比计算机断层扫描（CT）显示SBO没有绞窄的迹象，假设是由MD和伴随的MDB引起的，导致保守的管理。症状持续存在，需要对比增强CT。然而,在非对比CT上观察到的提示MD的扩张肠环在对比增强CT上无法证实.
方法：使用长管的减压疗法提供了最小的缓解，提示在入院后第5天进行腹腔镜手术，以达到诊断和治疗目的。
结果：MD切除可有效缓解SBO。组织病理学分析显示一个真正的憩室与异位胰腺组织，确认MD的诊断。在乐队现场，血管和神经结构被包裹在鞘中，与卵黄导管肠系膜的残留物一致；在组织病理学上被诊断为MDB。术后进展顺利，病人在第9天出院,术后。
结论：基于SBO术前工作诊断的减压治疗和策略性腹腔镜手术取得了良好的结果，强调早期临床怀疑MD和伴随的MDB的重要性，作为SBO的病因。成人MD的影像学变异性和稀有性强调了提高意识和准确诊断以实现最佳管理的必要性。对于怀疑肠缺血的患者应考虑早期干预。然而,该病例强调了在成人MD相关SBO治疗中进行战略规划和采用微创技术的临床意义.
