Li Ming,Li Yong,Huang Zhao.Diagnosis and treatment of multiple ileal diverticulum and intestinal duplication in children: a report of 6 cases[J].Journal of Clinical Pediatric Surgery,,20():168-171,186.[doi:10.12260/lcxewkzz.2021.02.011]
Diagnosis and treatment of multiple ileal diverticulum and intestinal duplication in children: a report of 6 cases
- Keywords:
- Intestines/AB; Ileal Diverticulum; Multiple; Child
- CLC:
- R574 R726
- Abstract:
- Objective To explore the clinical features,diagnosis and treatment of multiple ileal diverticulum and intestinal duplication in children.Methods A total of 546 children with Meckel’s diverticulum or intestinal duplication were treated.There were 6 cases of multiple ileal diverticulums or diverticulum associated intestinal duplication.Their clinical data were collected and analyzed retrospectively.Results The clinical manifestations were gastrointestinal hemorrhage,intestinal obstruction and abdominal infection.There were recurrent intussusception (n=1),intestinal obstruction (n=2),gastrointestinal hemorrhage (n=2) and abdominal infection (n=1).Laparoscopic exploration or laparotomy was performed,including laparotomy (n=3) and laparoscopy (n=3).Secondary surgery was performed (n=1).And secondary intussusception recurred at Month 6 after laparoscopic exploration.Diverticulum resection and laparoscopic re-exploration was performed.Two-site intestinal anastomosis (n=4) and one-site intestinal anastomosis (n=2) were performed.All cases recovered well postoperatively without anastomotic leakage.Conclusion Single intestinal diverticulum and intestinal duplication are common in children while multiple type is rare.Multiple lesions are prone to missing.The symptoms and signs are similar between single and multiple types.Meticulous intraoperative exploration is a diagnostic key of multiple lesions.Multiple bowel resection and anastomosis are both safe and feasible.
References:
1 李正,王慧贞,吉士俊.实用小儿外科学[M].第1版,北京:人民卫生出版社,2001:711-723. Li Z,Wang HZ,Ji SJ.Practical Pediatric Surgery[M].First Edition,Beijing:People’s Medical Publishing House,2001:711-723.
2 Yu M,Fang Z,Shen J,et al.Double simultaneous intussusception caused by Meckel’s diverticulum and intestinal duplication in a child[J].J Int Med Res,2018,46(8):3427-3434.DOI:10.1177/0300060518777337.
3 陈秀兰,吴永隆,李晓庆,等.儿童梅克尔憩室的诊断及并发症的临床分析[J].临床小儿外科杂志,2017,16(1):60-64.DOI:10.3969/j.issn.1671-6353.2017.01.014. Chen XL,Wu YL,Li XQ,et al.Diagnosis and complications of Meckel’s diverticulum in children[J].J Clin Ped Sur,2017,16(1):60-64.DOI:10.3969/j.issn.1671-6353.2017.01.014.
4 Charki MT,Oukhouya MA,Benmassaoud Z,et al.Complications of Meckel’s diverticulum in children:about 18 cases[J].Pan Afr Med J,2019,33:113.DOI:10.11604/pamj.2019.33.113.18756.
5 霍亚玲,郑彬,谷慧慧,等.高频超声对小儿梅克尔憩室的诊断价值及漏诊误诊分析[J].中国超声医学杂志,2019,35(1):29-31.DOI:10.3969/j.issn.1002-0101.2019.01.011. Huo YL,Zheng B,Gu HH,et al.High-resolution ultrasound in the diagnosis of Meckel’s diverticulum in pediatric patient[J].Chinese J Ultrasound Med,2019,35(1):29-31.DOI:10.3969/j.issn.1002-0101.2019.01.011.
6 Choi SY,Hong SS,Park HJ.The many faces of Meckel’s diverticulum and its complications[J].J Med Imaging Radiat Oncol,2017,61(2):225-231.DOI:10.1111/1754-9485.12505.
7 林玲玲,宋樟伟,赵雅萍,等.多层螺旋CT与超声对肠重复畸形的诊断价值[J].医学影像学杂志,2018,28(11):1939-1942.DOI:1006-9011(2018)11-1939-03. Lin LL,Song ZW,Zhao YP,et al.Values of MSCT and ultrasound in diagnosing intestinal duplication[J].J Med Imaging,2018,28(11):1939-1942.DOI:1006-9011(2018)11-1939-03.
8 Spyridakis I,Lopresti D,Georga S,et al.Tubular intestinal duplication harboring gastric ectopia accurately diagnosed by Tc-99m pertechnetate single-photon emission computed tomography/computed tomography Meckel’s scan[J].Indian J Nucl,2017,32(4):361-362.DOI:10.4103/ijnm.IJNM_25_17.
9 Irvine I,Doherty A,Hayes R.Bleeding Meckel’s diverticulum:A study of the accuracy of pertechnetate scintigraphy as a diagnostic tool[J].Eur J Radiol,2017,11(96):27-30.DOI:10.1016/j.ejrad.2017.09.008.
10 Yang JG,Ma DQ,Hao RR,et al.Detection of double Meckel diverticulum by Meckel scan[J].Clin Nucl Med,2008,33(10):729-730.DOI:10.1097/RLU.0b013e318184bf45.
11 Yang JG,Yin CH,Li CL,et al.Meckel’s diverticulum and intestinal duplication detected by Tc-99m pertechnetate scintigraphy[J].Clin Nucl Med,2010,35(4):275-276.DOI:10.1097/RLU.0b013e3181d18eca.
12 Lin L,Liu K,Liu H,et al.Capsule endoscopy as a diagnostic test for Meckel’s diverticulum[J].Scand J Gastroenterol,2019,54(1):122-127.DOI:10.1080/00365521.2018.1553353.
13 梅董昱,严志龙,陈盛.腹腔镜下儿童肠重复畸形的外科治疗[J].临床小儿外科杂志,2017,16(6):569-573.DOI:10.3969/j.issn.1671-6353.2017.06.010. Mei DY,Yan ZL,Chen S.Laparoscopy in the management of pediatric intestinal duplication[J].J Clin Ped Sur,2017,61(2):225-231.DOI:10.1111/1754-9485.12505.
14 闫学强,李欢,卞红强,等.完全腹腔镜下肠肠吻合技术在消化道畸形中的运用[J].中华小儿外科杂志,2017,38(9):666-670.DOI:10.3760/cma.j.issn.0253-3006.2017.09.005. Yan XQ,Li H,Bian HQ,et al.Application of total laparoscopic enteroanastomosis for digestive tract malformation[J].Chin J Pediatr Surg,2017,38(9):666-670.DOI:10.3760/cma.j.issn.0253-3006.2017.09.005.
15 Duan X,Ye G,Bian H,et al.Laparoscopic vs laparoscopicallyassisted management of Meckel’s diverticulum in children[J].Int J Clin Exp Med,2015,8(1):94-100.
16 Grimm C,Harter P,Alesina PF,et al.The impact of type and number of bowel resections on anastomotic leakage risk in advanced ovarian cancer surgery[J].Gynecol Oncol,2017,146(3):498-503.DOI:10.1016/j.ygyno.2017.06.007.
Memo
收稿日期:2019-04-13。
基金项目:湖南省出生缺陷协同防治科技重大专项（编号：2019SK1010）
通讯作者:李勇,Email:liyongpuwaike@163.com