小网膜裂孔疝致肠坏死一例误诊并文献荟萃分析

Lesser Omental Hernia with Intestinal Necrosis of Literature Analysis

目的探讨小网膜裂孔疝的临床特点、诊治方法及误诊原因。方法回顾性分析1例小网膜裂孔疝致肠坏死误诊病例资料,并检索中国生物医学文献数据库、CNKI、万方数据库、VIP数据库、中国学术期刊网络出版总库和中文科技期刊数据库建库至2015年7月的相关文献,对纳入文献的临床资料进行汇总分析。结果本例因腹痛、腹胀伴肛门停止排气、排便1 d就诊,外院曾诊断为胃肠炎,予相应治疗无明显好转来我院。腹部CT检查示:小肠肠管扩张、积气、积液,气液平面形成,诊断肠梗阻,保守治疗无效,剖腹探查发现胃体经小网膜裂孔疝出至胃体前部,确诊为小网膜裂孔疝,行手术治疗痊愈。经数据库检索,最终纳入32篇文献累计37例患者,其中仅1例术前经腹部CT检查确诊,余分别误诊为肠梗阻20例,消化道穿孔3例,胆囊炎2例,腹腔肿物、肠系膜血栓形成、急性阑尾炎、急性胰腺炎、腹腔出血各1例,未明确诊断6例;37例均予手术治疗,术中发现腹腔脏器畸形3例,2例因术后并发症死亡,余痊愈。结论小网膜裂孔疝临床表现无特异性,起病急骤、进展快,临床诊断较困难,及时剖腹探查并手术治疗是明确诊断和改善预后的关键。

Objective To investigate the clinical characteristics, diagnosis, treatment and misdiagnosis causes of hernia through the lesser omentum. Methods Clinical data of one misdiagnosed case of strangulated internal hernia through the lesser omentum with intestinal necrosis was retrospectively analyzed. We also reviewed the data about lesser omental in the China biomedical literature database, CNKI, Wan Fang, VIP, Database of Chinese Periodicals of Science and Technology up to July, 2015. Results A patient with abdominal pain, abdominal distension and no defecation accompanied for 1 day was diagnosed with gastroenteritis and had no significant improvement after treatment in other hospitals. In our hospital he had bowel dilatation, intestinal pneumatosis, effusion, gas-liquid plane formation, and was diagnosed as having intestinal obstruc- tion. The gastric body was found to be in the anterior part of the stomach surgery. The patient was cured after operation. In database searching, 32 articles concerning 37 cases were included. In the 38 cases of the literature review, only 1 case was di- agnosed by CT scanning before operation. The misdiagnosed diseases included intestinal obstruction （21 cases） , digestive tract perforation （3 cases）, cholecystitis （2 cases）, abdominal mass （1 case）, mesenteric thrombosis （1 case）, appendicitis （ 1 case） , acute pancreatitis （ 1 case） and intraabdominal hemorrhage （ 1 case） , and the others were undefined. All the pa- tients underwent surgical treatment, including 3 cases of abdominal organ malformation. 2 patients died, and the others were cured. Conclusion Lesser omental hernia has such characteristics as non-specific clinical manifestations, abrupt onset and rapid progress, therefore clinical diagnosis is difficult. Prompt exploratory laparotomy plus surgical approach is the key in diag- nosis and good prognosis.