背景:坐位无内脏,内脏器官是其正常生理位置的镜像,可以是全部或部分。持续下降的中结肠(PDM)是一种先天性异常,由于其长度短而无症状。导致肠梗阻的PDM是已知的临床并发症。
方法:一名74岁女性出现了2个月的气尿和肠尿,和复发性膀胱炎一个月。增强的计算机断层扫描(CT)显示膀胱中的空气以及乙状结肠憩室粘附在其上,怀疑是瘘管.CT还显示肝总动脉部分位置倒置,和肠系膜上动脉(SMA)异常产生的左绞痛动脉。由于憩室炎引起的慢性炎症引起的增厚和疤痕组织,使用超范围夹闭系统进行微创内窥镜闭合很困难。因此,进行乙状结肠切除术以关闭瘘管.术中,我们注意到一个异常固定的下降的中结肠。由于吻合口漏,在术后第六天进行了紧急再次手术。缝合失败归因于这些先天性异常,这是由于缺乏边缘血管的血流不足以及粘连引起的高结肠内压力所致。进行乙状结肠再切除和回肠造口术的成熟。患者术后无特异性并发症,三个月后关闭了回肠造口术。
结论:我们报告了一例极为罕见的因PDM引起的结肠膀胱瘘病例,该患者患有部分位置倒置,分支异常源自SMA。
BACKGROUND: Situs inversus viscerum, a congenital condition in which the visceral organs are a mirror image of their normal physiological positions, could be total or partial. Persistent descending mesocolon (PDM) is a congenital anomaly that is asymptomatic because of its short length. PDM causing intestinal obstruction is a known clinical complication.
METHODS: A 74-year-old woman presented with pneumaturia and enteruria for two months, and recurrent cystitis for a month. An enhanced computed tomography (CT) showed air in the bladder along with sigmoid colonic diverticula adherent to it, suspecting a fistula. The CT also showed partial situs inversus with the common hepatic artery, and left colic artery arising abnormally from the superior mesenteric artery (SMA). Minimally invasive endoscopic closure using the over-the-scope clipping system was difficult because of thickening and scar tissue due to chronic inflammation from diverticulitis. Thus, a sigmoidectomy was performed to close the fistula. Intraoperatively, we noted an abnormally fixed descending mesocolon. An emergency reoperation was performed on the sixth postoperative day owing to an anastomotic leak. Suture failure was attributed to these congenital abnormalities due to insufficient blood flow from an absent marginal vessel and a high endocolonic pressure by adhesions. Sigmoid colon re-resection and maturation of an ileostomy was performed. The patient had no specific postoperative complications, and the ileostomy was closed after three months.
CONCLUSIONS: We report an extremely rare case of colovesical fistula due to a PDM in a patient having partial situs inversus with abnormal branches originating from the SMA.