腸管逆回転症(Reversed Rotation)の1例

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  • Reversed Rotation in an Infant : A Case Report

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A male neonate 2 days after birth was admitted to this hospital presenting with frequent vomiting, which improved within a few days. Passage of G. I. tract seemed to be good by the initial gastrografin meal examination. Vomiting, however, continued intermittently for about two months, and the repeated upper gastrointestinal series revealed markedly delayed emptying of the gastric contents, associated with bird's beak sign, and laparotomy was done. A clockwise volvulus of the midgut through 360° was reduced. The splenic flexure and descending colon were normally located, but the cecum into which the terminal ileum emptied from the cranial was situated in the right flank with the colon passing transversely and thereafter running to the cranial. No hepatic flexure was present, and the greater omentum was scanty without attachment to the colon. The duodenum and jejunum were buried in the abnormal adhesion between those and the mesentery of the right colon, passing towards the left across the midline, then turning to the right, and consequently reappearing cut of the abnormal adhesion. The small intestine occupied the right side of the abdomen. The superior mesenteric artery was situated behined the duodenum. This condition seemed to be the prearterial right-sided cecum, according to the classification of reversed rotation by Amir-Jahed. Bill's procedure in addition to Ladd's operation was performed, and postoperative recovery was uneventful. The reversed rotation is extremely rare, and up to date about 50 cases have been found in the oversea literature, and only about 20 cases have been reported in Japan.

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