先天性 腸異常廻轉 = Congenital Malrotation of Intestine

다국어 초록 (Multilingual Abstract)

Malrotation of intestine may be careless by surgeon to study. Without study of the intestinal rotation in embryonic stage, it will be difficult to understand and many clinical points would be overlooked.
A clear conception of the ultimate position and fixation of abdominal viscera is conducive to more comprehension, diagnosis and more rational surgical procedure.
In early embryo, intestinal tract is a straight structure suspended by common dorsal mesentery, which is schematically represented as in Fig. 3. Intestinal rotation is a process which the straight structure of embryo convert until normal baby is born.
Process of the intestinal rotation is divided by Robbin into three stages. The first stage includes the time during which the mid gut loop occupies the umbilical hernia and until it is returned to the abdominal cavity at about the tenth week. Failure of the intestinal rotation beyond the first stage is seen in omphalocele, in which condition the embryonic hernia into the root of the umbilical cord persist in part or in full until birth.
The second stage occupies the time during which rotation and reduction of the mid gut into the abdominal cavity takes place and is completed when the cecum reaches the right loin in the eleventh week. Failure of the intestinal rotation on this second stage is seen in nonrotation, malrotation, reverse rotation or internal hernia.
The third stage extends from this time until shortly after birth. It is characterized by descent of the cecum and by fixation of the cecum and lower part of the duodenum by fusion of their mesenteries with the posterior parietal pertioneum. Incomplete intestinal rotation or failure of this rotation on the third stage are seen in subhepatic appendix, retroceceal appendix or mobile cecum.
Malrotation of intestine beyond first stage and on second stage is rare disease. During the past 15 years covered by Snyder's report at children hospital, 1937-1952, 3,861 abdominal operations: excluding hernias were performed on infants and children. There were 40 cases of malrotation in this series, making an incidence of about 1 percent.
Symptoms of this disease are various. About 75 percent of this disease develop symptoms within one week of age in Snyder's series. In our experience, 2 out of 3 cases developed mild symptoms, occasional abdominal distention and vomiting in early infancy. Most common symptoms of this disease are nausea, vomiting and distended abdomen due, to band and volvulus.
In the diagnoses of malrotation of intestine, roentgenologic study is the most helpful.
Treatment of this trouble is operation, lysis, detorsion and fixation. Snyder and many other surgeons tried a method of no fixation of the intestine in its normal position after being freed the bowel is returned to the abdomen. Wangensteen reported a method of fixation of intestine in its normal position. In our experience, no fixation of bowel in normal position were done in two cases and the postoperative course was uneventful until discharge from our hospital and follow up study was satisfactory.