背景:Meckel憩室是一种常见的先天性小肠畸形,最常见的三种并发症是梗阻,穿孔,和炎症。迄今为止,世界上只有少数病例报告。在儿童中,临床症状与阑尾炎相似。由于大多数成像特征是非特异性的,术前诊断不准确。此外,临床特征与小儿急性阑尾炎高度相似,因此,需要特别注意区分Meckel憩室和小儿阑尾炎。疾病控制不佳的患者应进行腹腔镜探查,以避免严重并发症,包括肠坏死,肠穿孔和消化道出血。
方法:本报告介绍儿童阑尾炎合并肠梗阻3例,这是由Meckel憩室顶部的纤维带(韧带)引起的,憩室穿孔,和憩室炎症。所有三个病人,年龄11-12岁,以急性阑尾炎为初始临床表现。所有患者均接受腹腔镜手术治疗,结果良好。包括临床表现的完整数据集,诊断成像,手术信息,还提供了组织病理学发现。
结论:Meckel憩室及其并发症的术前诊断具有挑战性,因为其临床体征和并发症与儿童阑尾炎相似。腹腔镜联合剖腹手术有助于诊断和治疗。
BACKGROUND: Meckel\'s diverticulum is a common congenital malformation of the small intestine, with the three most common complications being obstruction, perforation, and inflammation. To date, only a few cases have been reported worldwide. In children, the clinical symptoms are similar to appendicitis. As most of the imaging features are nonspecific, the preoperative diagnosis is not precise. In addition, the clinical characteristics are highly similar to pediatric acute appendicitis, thus special attention is necessary to distinguish Meckel\'s diverticulum from pediatric appendicitis. Patients with poor disease control should undergo laparoscopic exploration to avoid serious complications, including intestinal necrosis, intestinal perforation and gastrointestinal bleeding.
METHODS: This report presents three cases of appendicitis in children combined with intestinal obstruction, which was caused by fibrous bands (ligaments) arising from the top part of Meckel\'s diverticulum, diverticular perforation, and diverticular inflammation. All three patients, aged 11-12 years, had acute appendicitis as their initial clinical presentation. All were treated by laparoscopic surgery with a favorable outcome. A complete dataset including clinical presentation, diagnostic imaging, surgical information, and histopathologic findings was also provided.
CONCLUSIONS: Preoperative diagnosis of Meckel\'s diverticulum and its complications is challenging because its clinical signs and complications are similar to those of appendicitis in children. Laparoscopy combined with laparotomy is useful for diagnosis and treatment.