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Laparoscopy in children with acute intestinal obstruction by aberrant congenital bands
Yu-Tang Chang1, Bai-Hsiun Chen, Hsiang-Hung Shih
1Division of Pediatric Surgery, Department of Surgery, Kaohsiung Municipal Hsiao-Kang Hospital, Faculty of Medicine, College of Medicine, Graduate Institute of Medicine, Kaohsiung, Taiwan. 890300@ms.kmuh.org.tw
Insights
Aberrant congenital bands can cause acute intestinal obstruction in children. Laparoscopic surgery proved safe and effective for treating these rare cases, even when delayed.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Congenital Abnormalities
Background:
- Acute intestinal obstruction in children is often caused by congenital anomalies.
- Aberrant congenital bands are a rare but significant cause, posing diagnostic challenges.
- Terminal ileal herniation due to such bands requires prompt diagnosis and management.
Observation:
- Two pediatric cases of acute terminal ileal herniation caused by aberrant congenital bands were observed.
- Case 1 involved a mesodiverticular band with concurrent filmy membranes; Case 2 featured an anomalous ileocecal band.
- Both cases presented with non-compromised vascularity of the herniated intestine.
Findings:
- Laparoscopy was successfully performed 84 and 93 hours after symptom onset in the respective cases.
- The obstruction was attributed to single vascular bands, not cohesive adhesions.
- The first case represents a unique report of incomplete regression of vitelline circulation and ventral mesentery.
Implications:
- Laparoscopy is a safe and effective diagnostic and therapeutic tool for congenital band-related intestinal obstruction.
- Early surgical intervention, even after a delay, can yield positive outcomes.
- Understanding the embryological origins of these bands aids in surgical planning and diagnosis.
Abstract:
Aberrant congenital bands are a rare cause of acute intestinal obstruction and usually present a diagnostic challenge. In 2008, the authors encountered 2 children with acute terminal ileal herniation. In the first case, it was caused by a mesodiverticular band, and numerous freely hanging filmy membranes attached to the antimesenteric side of the small intestine were found concurrently; whereas, an anomalous band from the distal ileum to the cecum was the leading cause in the second case. The vascularity of both herniated intestines was not compromised, and laparoscopy was successfully carried out 84 and 93 hours after the onset of the symptoms, respectively. Instead of cohesive adhesions, both of the causes related to a single vascular band, and laparoscopy was an effective and safe tool in diagnosis and subsequent treatment. The case with a mesodiverticular band and filmy membranes is the first case report with incomplete regression of both the vitelline circulation and the ventral mesentery.
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