背景:网膜扭转是由网膜沿其长轴扭转引起的急性腹痛的罕见原因,从而损害了它的血管分布。它的表现是非特异性的,可以模仿其他常见的病理,使术前诊断具有挑战性。
方法:一名44岁女性因脐周腹痛就诊。她的实验室结果显示没有白细胞增多,CRP在正常范围内。经口和静脉造影的腹部和骨盆CT扫描显示右侧有一个界限分明的包块,主要提示肠系膜内疝伴绞窄。患者最终需要腹腔镜手术干预。
结论:大网膜扭转患者的急腹症表现是由于动脉供应和静脉引流阻塞后扭转远端水肿和坏死组织的发展。右胃上动脉周围旋转被认为是大网膜扭转的最常见原因。原发性扭转被认为是特发性的,而继发性扭转是由于可识别的易感病理如网膜囊肿而发生的,疝气,粘连,或者腹内肿瘤.由于网膜扭转的症状是非特异性的,重要的是要考虑鉴别诊断和排除其他原因引起的急腹症。当诊断不确定时,手术干预是主要的治疗方法,或者当病人的临床,放射学,保守治疗会使实验室检查结果恶化。
结论:大网膜扭转病例的早期手术干预可降低脓肿形成的发生率,粘连,和网膜坏死.在非手术候选人的情况下,保守治疗是最佳选择;因此,网膜扭转治疗的选择应根据具体情况加以考虑.
BACKGROUND: Omental
torsion is a rare cause of acute abdominal pain caused by twisting of the omentum along its long axis, thus compromising its vascularity. Its presentation is non-specific and can mimic other common pathologies, making its pre-operative diagnosis challenging.
METHODS: A 44-year-old female presented for periumbilical abdominal pain. Her laboratory results showed no leukocytosis and CRP was within normal range. CT scan of the abdomen and pelvis with oral and IV contrast showed a well demarcated pericecal mass at the right side, mostly suggestive of transmesenteric internal herniation with strangulation. The patient eventually required laparoscopic surgical intervention.
CONCLUSIONS: The acute abdominal manifestations in patients with omental
torsion are due to the development of edema and necrotic tissue distal of the torsion after the arterial supply and venous drainage have been obstructed. Rotation around the right gastroepiploic artery is considered to be the most common cause of omental torsion. Primary
torsion is considered to be idiopathic, while secondary
torsion occurs due to an identifiable predisposing pathology such as omental cysts, hernias, adhesions, or intra-abdominal tumors. Since symptoms of omental torsion are non-specific, it is crucial to consider the differential diagnosis and rule out other causes of acute abdomen. Surgical intervention is the mainstay treatment when there is uncertainty in the diagnosis, or when the patient\'s clinical, radiological, and laboratory findings worsen with conservative treatment.
CONCLUSIONS: Early surgical intervention in cases of omental
torsion reduces the incidence of formation of abscesses, adhesions, and omental necrosis. In cases of non-operative candidates, conservative treatment is the best option; therefore, the choice of treatment of omental torsion should be considered on a
case-by-
case basis.