Oclusión intestinal mecánica secundaria a hernia de Littré / Mechanical Intestinal Occlusion Secondary to Littré's Hernia

Introducción: La hernia de Littré se define como la presencia de un divertículo de Meckel en cualquier orificio herniario. Se han reportados muy pocos casos en la literatura por su frecuencia tan baja referida al 2 por ciento de la población general. Objetivo: Reportar y compartir el tratamiento exitoso de un caso clínico poco frecuente de oclusión intestinal mecánica por hernia de Littré. Caso clínico: Se trata de un paciente masculino, de 69 años de edad, raza blanca y con antecedentes de hipertensión arterial hace siete años, para lo que lleva tratamiento regular con captopril. Acudió al Servicio de Urgencias de Cirugía general del Hospital Clínico Quirúrgico Docente "Lucía Íñiguez Landín" por presentar dolor abdominal tipo cólico localizado difusamente, de moderada intensidad, sin irradiación precisa y acompañado de dos vómitos biliosos de poca cantidad, además de parada de la emisión de gases y heces fecales dos días antes, por lo que se ingresó para tratamiento quirúrgico urgente con diagnóstico de oclusión intestinal mecánica. Conclusiones: El diagnóstico preoperatorio de la hernia de Littré es poco probable, sobre todo si se acompaña de oclusión intestinal por lo que casi siempre es transoperatorio. El tratamiento quirúrgico del divertículo depende del estado inflamatorio y vascular(AU)

Introduction: Littré's hernia is defined as the presence of a Meckel's diverticulum in any hernial orifice. Very few cases have been reported in the literature because of its very low frequency, referred to as of 2 percent of the general population. Objective: To report and share the successful management of a rare clinical case of mechanical intestinal occlusion due to Littré's hernia. Clinical case: This is the case of a 69-year-old white male patient with a history of arterial hypertension for seven years, for which he has been receiving regular treatment with captopril. He went to the general surgery emergency department of Lucía Íñiguez Landín Clinical Surgical Teaching Hospital for presenting diffusely localized colicky abdominal pain, of moderate intensity, without precise irradiation and accompanied by two small amounts of bilious vomiting, in addition to stopping gas and stool emission two days earlier, for which he was admitted for urgent surgical treatment with a diagnosis of mechanical intestinal occlusion. Conclusions: The preoperative diagnosis of Littré's hernia is unlikely, especially if accompanied by intestinal occlusion, a reason why it is almost always transoperative. The surgical treatment of the diverticulum depends on the inflammatory and vascular status(AU)

Type IV jejunal atresia in a newborn: a rare birth defect presenting with bilious vomiting

Background: Type IV jejunal atresia is a rare birth defect, which occurs due to late intrauterine vascular accidents that results in complete obstruction of intestinal lumen. There is no genetic predilection. It occurs most commonly in proximal jejunum. Clinical presentation includes bilious vomiting, abdominal distension, feeding difficulties, failure to pass stools and/or absence of bowel movements after birth. Here author report a case of premature newborn, who was admitted in NICU at birth in view of prematurity. As the baby had bilious vomiting and bilious NG aspirate on day 3 of life, possibility of intestinal obstruction was kept. It was diagnosed as a case of jejunal atresia by abdominal radiograph displaying dilated stomach, duodenum and proximal jejunum with gasless abdomen. Further jejunal atresia confirmed by the upper GI study exhibiting the level of obstruction. Surgical resection of the atretic segment and primary anastomosis was done. This case emphasizes the need of rapid identification of jejunal atresia and its adequate management to prevent morbidity and mortality associated with fore shortened intestine.

A Clinical Review of Symptomatic Intestinal Malrotation

PURPOSE: Intestinal malrotation can have variable clinical presentations, and is a disease that may cause bilious vomiting. This study was performed to analyze the clinical characteristics of patients with symptomatic intestinal malrotation. METHODS: From Jan 2001 to Dec 2005, 11 cases of malrotation, receiving surgical procedure, and were retrospectively reviewed for their clinical characteristics. RESULTS: There were 8 male (72.7%) and 3 female (27.3%) patients. At the time of the operation, 10 patients (90.9%) were in the neonatal period. According to the clinical manifestations, bilious vomiting was seen in all cases (100%), with other symptoms (fever, lethargy and abdominal distention) observed in certain cases. Of the several diagnostic tools available, abdominal sonography and UGI series showed sensitivities of 100%. According to the operative findings, 6 cases (54.5%) had malrotation only, with the other 5 (45.5%) having additional midgut volvulus. The Ladd procedure was routinely performed in all cases, with additional detorsion or bowel resection performed in the cases of malrotation with midgut volvulus. After a definite procedure, an adhesive intestinal obstruction developed in 3 cases (27.3%), with surgical correction for the obstruction performed in one case. There were no cases of mortality. CONCLUSION: Intestinal malrotation could be of preferential concern for those neonates presenting with bilious vomiting. The proper diagnosis, via abdominal sonography, and early surgical management for intestinal malrotation will show a good result.