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Abstract: This article introduces a rare case of adult-type small bowel entrapment. The patient was a 45-year-old Ms. Mao, who came to our hospital with increased abdominal pain after a full meal, accompanied by nausea and vomiting. After the surgery, the small intestine was successfully released and the lipoma was removed, and she was finally discharged from the hospital.
Basic information】Female, 45 years old
Type of disease】Small intestine overlap, lipoma
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of Consultation】October 2021
Treatment plan】Surgical treatment (dissection, partial resection of intestinal canal, resection of mesenteric lipoma) + medication (ceftriaxone sodium for injection, metronidazole sodium chloride injection, glucose sodium chloride injection)
[Treatment period] 15 days of hospitalization and six months of follow-up
Effectiveness】The small intestine was released, the lipoma was removed, and the patient was discharged from the hospital and resumed normal life.
I. Initial consultation
The patient is a 45-year-old female, who developed paroxysmal vague pain in the left upper abdomen after a strenuous exercise more than one month ago, without any lumbar back pain or other abnormalities, so she did not pay attention to it. On admission, the patient was clear, mentally fine, poor diet, normal urine, small amount of anal venting, no bowel movement, and on examination, scattered pressure pain in the whole abdomen. The CT scan of the whole abdomen showed that the wall of the jejunum was thickened in the left epigastrium, and the jejunal intestinal tube and mesentery were visible in the intestinal lumen, and the proximal local intestinal fluid was obvious. Combined with the patient’s physical signs and CT examination, the preliminary diagnosis of small intestine entrapment was made, and the patient and his family were informed that surgery was needed as soon as possible.
II. Treatment process
Immediately after admission, the patient underwent routine blood and urine tests, five preoperative tests, electrocardiogram, chest X-ray and other relevant tests, which did not reveal any significant abnormalities and excluded other related diseases. After excluding the contraindications to surgery, a dissection was performed under general anesthesia, during which the jejunum intestinal tube and mesentery were found to be snapped into the intestinal cavity. In addition, there were several lipomas of different sizes attached to the mesentery of the remaining intestine, which were soft, with intact envelope and clear border. After the operation, the patient was given ceftriaxone sodium for injection combined with metronidazole sodium chloride injection as an anti-infection treatment, and glucose sodium chloride injection to replenish electrolytes and maintain blood volume. The stitches were removed 2 weeks after surgery and the patient was discharged from the hospital for recuperation.
(Colonoscopy: intussusception (consider tumor))
III. Treatment effect
The patient underwent surgery for small bowel entrapment, which was found to be caused by a lipoma, so the lipoma and part of the intestinal tube were removed. The patient’s diet was basically back to normal, anal discharge and bowel movement were normal, the quality of sleep was good, and the mental state was significantly improved compared with that at the time of admission, so the patient was discharged.
IV. Notes
We are glad that the patient’s condition has improved, but we still need to advise the patient to follow the doctor’s prescription and take the medication regularly after discharge, and then review the patient regularly. At the same time, do a good job of dietary management, mainly light, nutritious and easy to digest diet, avoid spicy, cold and other irritating food to stimulate the gastrointestinal tract, avoid overeating and ensure dietary hygiene. After discharge from the hospital, you can exercise appropriately, avoid heavy physical activities and strenuous exercise, maintain a comfortable living environment, pay attention to abdominal warmth, and avoid cold-induced gastrointestinal peristaltic disorders.
V. Personal insight
The incidence of small bowel entrapment is low in adults, and most of them are secondary to small bowel entrapment. The patient in this article is a small bowel entrapment caused by tumor, and it may also be related to trauma, intestinal inflammation and other factors. At present, the main treatment to reset the small intestine is enema or surgery. Enema is mostly applied to the young children with small intestine entrapment in mild condition, under the monitoring of ultrasound or X-ray, air or contrast enema is used to push the entrapped intestine back to its original position; surgery is mostly applied to adults or very serious young children with small intestine entrapment, for example, the patient in this article was determined to have small intestine entrapment caused by lipoma through abdominal dissection, and the lipoma and part of the intestine were removed to reset the entrapment. The patient in this article was determined to have a lipoma, and the lipoma and part of the intestine were removed to reposition the intussusception, and postoperative antibiotics were used to prevent infection. It is hoped that this case will raise the attention of patients with small bowel entrapment, which is an acute abdominal condition.