Meckel憩室(MD)是胃肠道最常见的先天性异常,在普通人群中患病率为1-3%。有症状的MD的手术治疗在文献中有很好的描述,但对于意外无症状MD的预防性切除指征仍未达成共识.为了解决这个问题,我们广泛回顾了目前的文献,并报告了我们在另一家医院进行的急性坏疽性阑尾炎腹腔镜阑尾切除术后2周的一例罕见的MD导致回肠扭转和急性腹膜炎的腹腔镜治疗经验.一名50岁的男子因急性和严重的腹痛出现在急诊科,呕吐,还有便秘.两周前,他在另一家医院接受了急性阑尾炎的腹腔镜阑尾切除术。病人患有脱衣症,心疼,寻求止痛药的位置。腹部轻度扩张和柔软,在中央象限,布隆伯格符号是轻度正的。临床表现因发烧而恶化,偏周,和白细胞增多。CT扫描显示回肠结附近的回肠-回肠粘连,上游回路随空气-液体水平扩张。通过紧急腹腔镜检查,坏死的肿块,MD,被楔形切除,周围的回肠扭转也被切除了.术后病程顺利。对于偶然无症状MD的适当管理没有明确的共识,尽管有几项研究试图确定指导标准。MD的特点,患者的危险因素,临床表现,需要考虑手术方法,以建立治疗偶发无症状MD的明确指南.由于缺乏明确的指导方针,个人专业知识和判断力是外科医生接近偶然无症状MD的主要资源。
Meckel\'s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract with a 1-3% prevalence in the general population. The surgical management of symptomatic MD is well described in the literature, but there is still no consensus on the indication for prophylactic resection of incidental asymptomatic MD. To address this issue, we extensively reviewed the current literature and report our experience with laparoscopic management of an unusual case of MD causing ileal
volvulus and acute peritonitis two weeks after a laparoscopic appendectomy for acute gangrenous appendicitis performed in another hospital. A 50-year-old man presented to the emergency department with acute and severe abdominal pain, vomiting, and constipation. He had undergone a laparoscopic appendectomy for acute appendicitis two weeks before in another hospital. The patient was apyretic, distressed, and seeking an antalgic position. The abdomen was mildly distended and tender, and the Blumberg sign was mildly positive in the central quadrants. The clinical picture deteriorated with fever, peritonismus, and leukocytosis. A CT scan showed an ileo-ileal adhesion near the ileocolic junction and dilatation of the upstream loops with the air-fluid levels. Through an urgent laparoscopy, a necrotic mass, the MD, was wedge-resected, and the surrounding ileal
volvulus derotated. The postoperative course was uneventful. There is no definitive consensus on the appropriate management of incidental asymptomatic MD, although several studies have attempted to identify guiding criteria. Features of the MD, the patient\'s risk factors, clinical presentation, and surgical approach need to be considered to establish definitive guidelines for the management of incidental asymptomatic MD. In the absence of definitive guidelines, personal expertise and judgement are the main resources for the surgeon approaching an incidental asymptomatic MD.