文章主要观点:本文对1例妊娠期小肠扭转患者的临床资料进行回顾性分析,为妊娠期小肠扭转的诊治提供思路。这种患有小肠扭转的妊娠病例为我们提供了以下诊断和治疗提示:1)在怀孕期间,孕妇的腹部体征通常不典型,尤其是在怀孕的中后期。诊断肠扭转往往很棘手,容易与先兆流产等产科急症混淆,早产疼痛,胎盘早剥,还有子宫破裂.也很难与急性胰腺炎等外科急症区分开来,急性阑尾炎,和胃肠道穿孔。当孕妇出现恶心时,呕吐,还有腹痛,在鉴别诊断中应考虑肠扭转。2)腹部CT,X光片,和其他放射学检查可能导致胎儿组织损伤和功能障碍。此外,超声诊断也受到子宫增大的限制,患者状况,和扫描范围,具有一定的漏诊和误诊风险。MRI因其无辐射、高分辨率等优点,已成为妊娠期急腹症的重要诊断工具。3)妊娠期肠扭转往往难以自我复位,可在短时间内导致肠坏死。在这种情况下,手术治疗通常是首选。对于患有急腹症的孕妇,我们应该坚持外科急腹症的诊断和治疗原则,掌握腹膜炎等手术探查的适应症,并及时进行手术治疗,避免病情进一步恶化,降低胎儿丢失的风险。
Article\'s main point: This article retrospectively analyzed the clinical data of a patient with small bowel torsion during pregnancy to provide ideas for diagnosing and treating small bowel torsion during pregnancy. This case of pregnancy with small intestinal volvulus gives us the following tips in the diagnosis and treatment: 1) During pregnancy, the abdominal signs of pregnant women are usually atypical, especially in the middle and late stages of pregnancy. Diagnosing intestinal torsion is often tricky and can easily be confused with obstetric emergencies such as threatened abortion, preterm labor pain, placental abruption, and uterine rupture. It is also difficult to distinguish from surgical emergencies such as acute pancreatitis, acute appendicitis, and gastrointestinal perforation. When pregnant women experience nausea, vomiting, and abdominal pain, intestinal torsion should be considered in the differential diagnosis. 2) Abdominal CT, X-ray, and other radiological examinations may cause fetal tissue damage and dysfunction. In addition, ultrasound diagnosis is also limited by the enlarged uterus, patient conditions, and scanning scope, which has a certain risk of missed diagnosis and misdiagnosis. MRI has become an important diagnostic tool for acute abdomen in pregnancy because of its non-radiation and high resolution. 3) Intestinal torsion during pregnancy is often difficult to self-reposition and can lead to intestinal necrosis in a short time. In such cases, surgical treatment is usually the first choice. For pregnant women with acute abdomen, we should adhere to the principles of diagnosis and treatment of the acute surgical abdomen, master the indications of surgical exploration such as peritonitis, and perform surgical treatment in time to avoid further deterioration of the condition and reduce the risk of fetal loss.