成人美克尔憩室所致急性肠梗阻的临床特点

Clinical features of adult patients with acute intestinal obstruction secondary to Meckel＇s diverticulum

目的 分析成人美克尔（Meckel）憩室所致急性肠梗阻的临床特点和诊治体会.方法 对9例美克尔憩室所致急性肠梗阻病例的临床资料和病理学特点进行回顾性分析.结果 9例患者均行手术治疗,经腹腔探查证实为美克尔憩室所致急性肠梗阻.术前仅1例患者确诊为美克尔憩室所致急性肠梗阻,8例仅诊断为肠梗阻;5例行憩室楔形切除术,4例行包括憩室在内的部分回肠切除术.术后病理学检查显示9例患者美克尔憩室均有炎性改变,部分病例憩室伴有黏膜糜烂、微小溃疡、出血或穿孔,4/9憩室中含有异位组织;全部患者术后均痊愈.结论 美克尔憩室是导致急性肠梗阻的少见病因,术前诊断困难,易发生肠绞窄,部分病例憩室中含有异位组织,应及时手术治疗.

Objective To analyze the clinical features of adult patients with acute intestinal obstruction secondary to Meckel＇s diverticulum and the experience in management of the disease.Methods The clinical data and pathological features of 9 patients with acute intestinal obstruction secondary to Meckel＇ s diverticulum were retrospectively analyzed. Results All patients were diagnosed with acute intestinal obstruction secondary to Meckel＇s diverticulum via abdominal cavity exploration and underwent surgical treatment. Before surgical treatment, 1 out of 9 patients was correctly diagnosed as acute intestinal obstruction secondary to Meckel＇s diverticulum, and the other 8patients were diagnosed as acute intestinal obstruction. Diverticulum was resected in 5 cases and the rest 4 cases received partial excision of small intestine including the diverticulum. Pathological examination showed that all patients had inflammatory changes in diverticulum. Some patients were complicated with mucosal erosion, small ulcers, bleeding or perforation. Forty-four percent （4/9） of diverticula contained ectopic tissue. All patients were cured. Conclusion Meckel＇s diverticulum is a rare cause of acute intestinal obstruction and preoperative diagnosis is difficult. Diverticulum,howere,is likelihood to develop strangulation or contains ectopic tissue, so that the surgical treatment should be performed early.