Case Report: 7-year-old boy with incarcerated internal hernia leading to extensive intestinal necrosis due to a large congenital mesenteric defect
We present a case of a 7-year-old boy with acute abdominal symptoms initially misdiagnosed as constipation. Delayed imaging diagnostics revealed an ileus with contorted small intestine, so laparotomy was indicated. An acute bowel obstruction was found based on an incarcerated internal hernia. Small...
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| Main Authors: | , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2021
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| In: |
Klinische Pädiatrie
Year: 2021, Volume: 233, Issue: 04, Pages: 189-193 |
| ISSN: | 1439-3824 |
| DOI: | 10.1055/a-1306-1213 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1055/a-1306-1213 Verlag, lizenzpflichtig, Volltext: http://www.thieme-connect.de/DOI/DOI?10.1055/a-1306-1213 
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| Author Notes: | Susanne Deeg, Sophie Krickeberg, Tauseef Nisar, Bogata Dora Schwarz-Bundy, Lucas Wessel |
MARC
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| 246 | 1 | |i Titel der deutschsprachigen Zusammenfassung |a Inkarzerierte innere Hernie mit ausgeprägten intestinalen Nekrosen aufgrund einer großen kongenitalen Mesenteriallücke bei einem 7-jährigen Jungen | |
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| 520 | |a We present a case of a 7-year-old boy with acute abdominal symptoms initially misdiagnosed as constipation. Delayed imaging diagnostics revealed an ileus with contorted small intestine, so laparotomy was indicated. An acute bowel obstruction was found based on an incarcerated internal hernia. Small and large bowel segments were incarcerated into a large mesenteric defect leading to extended intestinal necrosis. About 30 cm of necrotic small bowel and 15 cm of large intestine were resected, two primary anastomoses were performed. The mesenteric defect was closed with two running sutures. The boy’s clinical outcome was very good. Two aspects are discussed: the initial clinical misdiagnosis of acute bowel obstruction in a child leading to a delay of diagnostics and therapy on the one hand and the origin of mesenteric defects on the other. In children with abdominal pain, ultrasound must be performed as soon as possible and pediatric surgeons have to be involved early. There should be an awareness of the fact, that mesenteric defects and other congenital malformations can occur more often than we suspect it. In the case of an internal hernia, a misjudgement of the clinical condition may be very harmful for the patient and can lead to a short bowel syndrome or even death. | ||
| 520 | |a In dieser klinischen Fallvorstellung geht es um einen 7-jährigen Jungen mit akuter abdomineller Symptomatik, die initial als Obstipation fehlinterpretiert wurde. Die verzögert durchgeführte Bildgebung zeigte das Bild eines Ileus mit torquierten Dünndarmschlingen unklarer Ursache, daraufhin wurde die Indikation zur dringlichen Laparotomie gestellt. Intraoperativ wurde ein mechanischer Ileus basierend auf einer inkarzerierten inneren Hernie gefunden. In sich torquierte Anteile von Colon und Ileum waren in einer großen Mesenteriallücke inkarzeriert, die betroffenen Darmschlingen wiesen bereits ausgedehnte Nekrosen auf. Es wurden Darmsegmentresektionen von ca. 30 cm nekrotischem Ileum und 15 cm Colon mit primären Anastomosen durchgeführt. Der kongenitale Mesenterialdefekt wurde mit zwei fortlaufenden Nähten verschlossen. Der weitere klinische Verlauf war erfreulich. Zwei Aspekte dieses Falles werden besprochen: Einerseits die initiale klinische Fehleinschätzung des mechanischen Ileus bei diesem Kind, die zu einer verspäteten Diagnostik und Therapie führte, andererseits der Ursprung angeborener Mesenterialdefekte. Kinder mit relevanter Bauchschmerzsymptomatik sollten so früh wie möglich eine aussagekräftige Abdomensonographie erhalten, im besten Fall durchgeführt durch einen Kinderradiologen, ausserdem sollten Kinderchirurgen früh zur Mitbeurteilung involviert werden. Wir sollten uns dessen bewusst werden, dass angeborene Mesenteriallücken und andere intestinale Fehlbildungen häufiger als durch uns vermutet vorliegen können. Im Falle einer inneren Hernie kann eine klinische Fehleinschätzung dem Patienten massiv schaden und zu einem Kurzdarmsyndrom oder sogar zum Tode führen. | ||
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